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Fulltext Ethical challenges of digital health technologies: Aadhaar, India

Gopichandran V, Ganeshkumar P, Dash S, Ramasamy A

Bull World Health Organ, 2020 Apr 01;98(4):277-281.
PMID: 32284652 DOI: 10.2471/BLT.19.237123

Problem: The proliferation of information and communication technologies in India has enabled the emergence of health-related digital applications, from which important ethical issues arise.
Approach: The Aadhaar identification system provides each resident in India with a 12-digit unique identification number, linked to demographic and biometric data. Identification by Aadhaar in welfare programmes has the important advantage of ensuring targeted benefits reach the intended recipients.
Local setting: Some of the major issues faced by the public health sector in India are inadequate funding and inefficient utilization of the funds allocated. The enhancement of currently available digital health records will greatly increase the efficiency of the health care services.
Relevant changes: The Aadhaar identification system has been linked to several health programmes since 2013. Success was achieved in a programme encouraging pregnant women to undergo delivery at a health facility, as use of Aadhaar number ensured that cash incentives reached the correct recipient. However, interruptions in the treatment of patients with tuberculosis and acquired immunodeficiency syndrome have been reported in other health programmes, due to patients fearing a breach of their confidentiality.
Lessons learnt: Although the proposed merging of the Aadhaar identification system with digital health care records could enable greater efficiency in monitoring public health and welfare programmes, important ethical issues of privacy and data ownership and use must be considered. In joining the digital revolution, low- and middle-income countries must also develop strict legal regulation to protect data and avoid information technology companies exploiting such databases for profit.

Matched MeSH terms: Biometric Identification/ethics
Fulltext Ethics, professionalism and the "trade"

Rajakumar MK

National Conference on Managed Care, 1996.

Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 99-102

Matched MeSH terms: Ethics
Fulltext SMA Lecture: Ethical consequences of technological change

Rajakumar MK

Singapore Med J, 1984 Feb;25(1):1-5.
PMID: 6463657

Dr Rajakumar delivered this lecture at the 14th SMA National Medical Convention on 16.4.1983
Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 83-90

Matched MeSH terms: Ethics*
Fulltext Role of the Nasogastric Tube and Lingzhi (Ganoderma lucidum) in Palliative Care

Wang X, Huang Y, Radha Krishna L, Puvanendran R

J Pain Symptom Manage, 2016 Apr;51(4):794-799.
PMID: 26891608 DOI: 10.1016/j.jpainsymman.2015.11.028

Decision-making on behalf of an incapacitated patient at the end of life is a complex process, particularly in family-centric societies. The situation is more complex when attempts are made to accommodate Eastern concepts of end-of-life care with more conventional Western approaches. In this case report of an incapacitated 74-year-old Singaporean man of Malay descent with relapsed Stage 4 diffuse large B cell lymphoma who was without an established lasting power of attorney, we highlight the difficult deliberations that ensue when the patient's family, acting as his proxy, elected to administer lingzhi through his nasogastric tube (NGT). Focusing on the questions pertaining to end-of-life decision-making in Asia, we consider the issues surrounding the use of NGT and lingzhi in palliative care (PC) and the implementation of NGT for administering lingzhi in a PC setting, particularly in light of a dearth of data on such treatment measures among PC patients.

Matched MeSH terms: Phytotherapy/ethics; Palliative Care/ethics; Terminal Care/ethics
Fulltext A curriculum in medical ethics and medical humanities

Puthucheary SD

Med J Malaysia, 1980 Sep;35(1):86-95.
PMID: 7254006

The code of ethics derived from the Hippocratic Oath needs to be supplemented by a formal curriculum in Medical Ethics and Medical Humanities in our Medical schools. The need and justification for it, a review of the medical ethics curricula in American. European. British and Australian Universities, together with an outline of the proposed curriculum is described.

Matched MeSH terms: Ethics, Medical*; Codes of Ethics
Fulltext Inter-professional ethical values in Iranian aged care: a qualitative study

Hosseinabadi R, Abolfathi Momtaz Y, Mohammdi Shahboulaghi F, Abbaszadeh A, Ali Akbari Kamrani A, Pournia Y

Med Glas (Zenica), 2020 Feb 01;17(1):206-215.
PMID: 31432658 DOI: 10.17392/1049-20

Aim Ethical values are the basis of the behaviour and performance of professional care staff. This study aimed to identify inter-professional ethical values in aged care. Methods This qualitative thematic content analysis study was conducted in Khorramabad, Iran, from September 2018 to June 2109, and 36 core members of the aged care team (including 24 nurses, 5 physicians, 3 physiotherapists, and 4 social workers) were selected through the purposive sampling method and interviewed in depth. The data were analysed using the directed content analysis and the method of Zhang and Wildemuth. Results Four main themes of providing professional care, preserving the integrity of the aged, observing the dignity of the aged, establishing human relationship, along with 21 subthemes were extracted as ethical values in aged care. Conclusion The results of this study indicate that providing ethical aged care is influenced by the specific conditions of this age group. In addition to general ethical values such as providing professional care, providing ethical aged care is based on ethical values such as promoting social interaction, promoting peace and comfort, preserving and promoting independence, and autonomy in aged care. Promoting collaborative care and paying more attention to the human dimensions of communication and interaction were other emphasized values.

Matched MeSH terms: Ethics, Nursing*
Orthopaedic surgeons and the device industry: skeletons in the closet

Poduval M

Indian J Med Ethics, 2011 Apr-Jun;8(2):97-102.
PMID: 22106619

The relationship between orthopaedic surgeons and the device industry is one that is mutually beneficial and productive. However there are skeletons in the closet. The financial implications of this relationship have come under intense scrutiny. The sponsorships and the financial benefits of this symbiotic relationship have been found to cross the boundaries considered acceptable to ethical practice of the profession. In India, the ethical transgressions resulting from unhealthy associations between the orthopaedic surgeon and the industry have yet to be given due importance. Adequate rules and regulations are yet to be enforced and self-regulation is practically non-existent. It is essential to deal with the problem and potential implications that can arise from this kind of misconduct at the organisational level and enforce them for compliance.

Matched MeSH terms: Orthopedics/ethics*; Health Care Sector/ethics*
Post-disaster victimization: how survivors of disasters can continue to suffer after the event is over

Phua KL

New Solut, 2008;18(2):221-31.
PMID: 18511398 DOI: 10.2190/NS.18.2.k

When public health researchers study the health effects of disasters (whether "naturally-occurring," disasters due to failure of technology, or disasters due to terrorism), some aspects of the post-disaster situation of victims are often overlooked. Social science research has shown that the vast majority of people tend to behave altruistically during and after a disaster. Nevertheless, cases of victimization of survivors do occur. They can include post-disaster victimization of survivors by other individuals (including fellow survivors, opportunistic outsiders, and even unethical aid workers and rogue members of the police, armed forces or international organizations such as the United Nations), groups (such as organized criminal gangs) and institutions (through neglect, incompetence, bureaucratic inefficiency or through institutionalized discriminatory practices). In this article, various kinds of post-disaster victimization that can occur are discussed.

Matched MeSH terms: Relief Work/ethics
Fulltext Dental Home Visits for Caries Prevention Among Preschool Children: Protocol for a Cost-Effectiveness Analysis on a Randomized Control Trial

Andiesta NS, Hamid MA, Lee K, Pau A

JMIR Res Protoc, 2018 Jun 06;7(6):e10053.
PMID: 29875086 DOI: 10.2196/10053

BACKGROUND: In 2012, nearly 4000 children in Malaysia were referred to hospital pediatric dental services due to dental caries. Recent research has reported the effectiveness of dental home visits in preventing caries development in young children. Dental home visits (DHVs) are described as an ongoing relationship between the dentist and their patients, providing all aspects of a preventive oral health care program in the presence of the parents at home.
OBJECTIVE: The objective of this study is to evaluate the cost-effectiveness of dental home visits and oral health information, in the form of educational leaflets, in preventing new caries development in young children, compared to those receiving only educational leaflets over a period of two years. Cost-effectiveness analysis will be used to evaluate the cost-effectiveness of dental home visits.
METHODS: This is a collaborative project with the Oral Health Division of the Ministry of Health Malaysia. The Oral Health Division will provide access to a subsample from the National Oral Health of Preschoolers Survey which was carried out in 2015. The population of interest is children aged 5 and 6 years from kindergartens in the Selangor state of Malaysia. The study adopted a societal perspective for cost-effectiveness analysis and all types of resources that are of value to society will be included in analyzing the costs; such as cost to the patient, cost to the provider or institution, and indirect costs because of loss of productivity.
RESULTS: The trial has been approved by the International Medical University Malaysia's Joint Research and Ethics Committee (Project ID: IMU R157-2014 [File III - 2016]). This trial is currently recruiting participants.
CONCLUSIONS: The number of young children in Malaysia who have been referred to the hospital children's dentistry service for severe caries is disturbing. The cost of dental treatment in young children is high due to the severity of the caries which require an aggressive treatment, and the need for general anesthesia or sedation. This study will provide information on the cost and effectiveness of DHVs in caries prevention of young children in Malaysia.
REGISTERED REPORT IDENTIFIER: RR1-10.2196/10053.

Matched MeSH terms: Ethics Committees
Fulltext End-of-life decision and euthanasia from the Islamic perspective

Osman A

International Medical Journal Malaysia, 2007;6(1):1-10.
MyJurnal

The developments in the technology of life support such as mechanical ventilators, dialysis machines and cardiovascular support techniques have provided the means of maintaining organ function for prolonged period of time. However, in many instances, such life-sustaining treatment in intensive care units did not result in desirable outcome where patients return to their normal state of health. Several ethical issues have surfaced from these medical advances mainly on the decision-making process, which physicians have to deal in their daily practice. Withholding and withdrawing life-prolonging treatments that allow patients to die naturally need to be differentiated from physician-assisted suicides and euthanasia that involves the active ending of life. The definition of life and death and the guiding ethical principles that one takes before embarking to a particular conclusion is a pre-requisite to good clinical practice. Islam, as a comprehensive religion provides clear definition of life and death and has guidelines that underlie its own ‘medical ethics’ that one could be guided by to assist in the decision-making process.

Matched MeSH terms: Ethics, Medical
Fulltext An international survey of medical ethics curricula in Asia

Miyasaka M, Akabayashi A, Kai I, Ohi G

J Med Ethics, 1999 Dec;25(6):514-21.
PMID: 10635508

SETTING: Medical ethics education has become common, and the integrated ethics curriculum has been recommended in Western countries. It should be questioned whether there is one, universal method of teaching ethics applicable worldwide to medical schools, especially those in non-Western developing countries.
OBJECTIVE: To characterise the medical ethics curricula at Asian medical schools.
DESIGN: Mailed survey of 206 medical schools in China, Hong Kong, Taiwan, Korea, Mongolia, Philippines, Thailand, Malaysia, Singapore, Indonesia, Sri Lanka, Australia and New Zealand.
PARTICIPANTS: A total of 100 medical schools responded, a response rate of 49%, ranging from 23%-100% by country.
MAIN OUTCOME MEASURES: The degree of integration of the ethics programme into the formal medical curriculum was measured by lecture time; whether compulsory or elective; whether separate courses or unit of other courses; number of courses; schedule; total length, and diversity of teachers' specialties.
RESULTS: A total of 89 medical schools (89%) reported offering some courses in which ethical topics were taught. Separate medical ethics courses were mostly offered in all countries, and the structure of vertical integration was divided into four patterns. Most deans reported that physicians' obligations and patients' rights were the most important topics for their students. However, the evaluation was diverse for more concrete topics.
CONCLUSION: Offering formal medical ethics education is a widespread feature of medical curricula throughout the study area. However, the kinds of programmes, especially with regard to integration into clinical teaching, were greatly diverse.

Matched MeSH terms: Ethics, Medical*; Ethics, Clinical
Fulltext Review article : lawful and unlawful foods in Islamic law focus on Islamic medical and ethical aspects

Nurdeng D

International Food Research Journal, 2009;16(4):469-478.
MyJurnal

In this paper, attempts will be made to study and understand the lawful and unlawful foods in the light of Islamic Medical law focus on ethical aspect that has been practiced during Islamic civilization. We will realize that lawful and unlawful foods are not, as some imagine, mere pretense, but rather constitute the divine command which protects against many diseases. In order to present such a law, the jurists of Islam needed great acuteness and power of reflection to make them understand the matters relating to lawful and unlawful foods in Islam. To attempt to follow these jurists, in their treatment, of the different school of thoughts (madhahib) would take us far beyond the limits of this research. Thus, we will rather confine ourselves to those laws which are clearly stated in the Qur’an and tradition (hadith), as well as a few of the most important issues dealt with in the different school of thoughts (madhahib).

Matched MeSH terms: Ethics, Medical
Fulltext Ethical issues in qualitative research among postgraduate students in Malaysia

Nurshaidah Mohamad Sari, Nur Sofurah Mohd Faiz

Malaysian Journal of Qualitative Research, 2019;5(2):31-40.
MyJurnal

The issue in research ethics has been a long-standing problem in the academic world. In qualitative research, most of the studies carried out involve human subjects and require awareness of ethical issues that may arise, such as misconduct in research, plagiarism and authorship disputes. However, the emphasis on this issue has been given little exposure mostly among postgraduate students in Malaysia. This paper will highlight the most common ethical issues that arise in qualitative research studies, why this has happened, and how to overcome these important issues across institutions. In order to discover these issues, the databases Scopus, Google Scholar and Google Search were queried in the searching. The databases were assessed through the criteria of research ethics, research misconduct, and ethical issue in qualitative research from the year 1995 to 2019. The results revealed that there are studies on ethics in qualitative research especially in health and business area but insufficiently addressed in education. Besides, there are also several types of ethical problems in qualitative researches being identified which are commonly engaged by students despite research classes or courses that have been provided. Finally, it is concluded that not only does the research ethics component needs to be clearly addressed in the teaching among postgraduate students when conducting qualitative research, but there is also an urgent need to improve the institution curriculum in the research subject.

Matched MeSH terms: Ethics, Research
Fulltext The traditional practice in the hospital setting: what are the ethical implications?

Rosnani Zakaria, Muzaimi Mustapha, Tengku Alina Tengku Ismail, Bella Puvok, Kamarul Aryffin Baharuddin, Mohd Suhaimi Ab Wahab, et al.

Education in Medicine Journal, 2015;7(4):68-72.
MyJurnal

Myth, believe in powerful ‘being’ commonly known as jinn and usage of ‘bomoh’ as the medium is still widespread in our community in Kelantan especially among the Malay community. This believe and practice of usin ‘bomoh’ to cure and help with known and unknown disease believe to be caused by the jinn, occasionally poses a significant complication and threat to the management of patient in the hospital. Our case is just one of many cases that happen in our local hospital, and we hope by sharing this case will illustrate how ethical discussion occasionally surpassed the four common ethical pillars.

Matched MeSH terms: Ethics
Fulltext A Single Blinded Randomized Controlled Study of the Effect of Conventional Oral Hypoglycemic Agents Versus Intensive Short-Term Insulin Therapy on Pure Tone Audiometry in Type II Diabetes Mellitus

Asma A, Azmi MN, Mazita A, Marina MB, Salina H, Norlaila M

Indian J Otolaryngol Head Neck Surg, 2011 Apr;63(2):114-8.
PMID: 22468245 DOI: 10.1007/s12070-011-0132-y

Neuropathy is frequently a late complication of diabetes mellitus. Auditory neuropathy and microangiopathy of inner ear are the possible causes of hearing loss in diabetics. To study the correlation between glycaemic control and hearing threshold in patients with type 2 diabetes mellitus and to determine the differences of hearing threshold between groups treated with different modality. This single blind randomized controlled study was performed at the Department of Medicine and Department of Otorhinolaryngology, Hospital Universiti Kebangsaan Malaysia (UKM) between 1st May 2003 and 31st September 2004. This study was approved by Research Ethics Committee (code number FF-137). Subjects were randomized into two groups. Group 1 were patients treated with conventional oral hypoglycemic agents. The patients in group 2 were those treated with insulin injection. The subjects were seen 4 weekly for 3 months. Audiometric test were performed in all subjects at each visit. Blood were taken for fasting blood glucose, Hb1Ac, and fructosamine at every visit to determine the glycaemic controls of the subject. They were 11 patients (22 ears) treated with oral hypoglycemic agents and 17 patients treated (34 ears) with subcutaneous insulin. There is no significant difference between mean pure tone threshold before and after treatment at all frequencies in both groups. There is also no significance different in fasting glucose level and fructosamine. However, there is significant difference HbA1c levels between the two groups after treatment (P

Matched MeSH terms: Ethics Committees, Research
Fulltext Short review: Implementation of biomedical ethics in Malaysia

Maisarah AS, Nurul Ajilah MK, Siti Amalina MR, Norazuroh MN

Health and the Environment Journal, 2016;7:54-76.

This literature review focuses on the implementation of biomedical ethics in Malaysia based on the government and institutional settings. Insights of the development of biomedical ethics and the responsible entities, particularly the clinical trials that become the emerging field of interest by the government to boost the biomedical research in Malaysia are provided. Some issues and their implications for research and ethical review process in Malaysia are also elucidated. The review indicates the advancement of policies by the government in implementing the biomedical ethics with some affairs that should be a matter to be concerned.
Keywords: Biomedical, ethics, implementation, standards, research ethic committee, good laboratory practice.

Matched MeSH terms: Ethics, Research
Fulltext Family gives birth to school bully: truth or assumption?

V. C. Anuratha Subramaniam, Anisah Baharom, Nor Afiah Mohd. Zulkefli

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):102-102.
MyJurnal

Introduction: Family plays an important role in the development of an adolescent. Several theories postulate in-fluences of bully behaviours within family context. Persistent act of school bullying may lead to violence and eventually disruption of a normal adolescence mental health. This study was done to address whether family factors were associated with school bully perpetrator. Methods: This was a cross sectional study conducted among Form One students from twenty-five schools in Selangor. Parental and respondents’ consents were obtained prior to this research. Data was collected using a self-administered questionnaire comprising of sociodemographic data of the respondents, their family characteristics and parenting style. Cronbach alpha ranged from 0.70- 0.89. Data was analysed using SPSS v25. Ethical approval was obtained from the Ethics Committee for Research Involving Human Subject of Universiti Putra Malaysia (UPM). Results: Response rate was 92.7% with 1221 respondents. Majority of the respondents were females (62%), Malays (82.8%) and lived with married parents (91.2%). Prevalence of bully perpetrator was 12.8%. Parental marital status (p < 0.05), presence of substance abuse among family member (p < 0.05), presence of violence act among family member (p < 0.05), witnessing violence at home (p < 0.05), sibling violence (p < 0.05), presence of family hostility (p < 0.05) and permissive maternal parenting style ( p < 0.05) were associated with school bully perpetrators. Conclusion: This study showed the association between family factors and the development of school bully perpetrators. It is a strong message for parents, educators, policy makers and health providers to collaborate and redesign prevention programmes in an effort to contracept the birth of a school bully.

Matched MeSH terms: Ethics Committees
Islamic bioethical deliberation on the issue of newborns with disorders of sex development

Mohamed MS, Noor SN

Sci Eng Ethics, 2015 Apr;21(2):429-40.
PMID: 24664170 DOI: 10.1007/s11948-014-9534-z

This article presents the Islamic bioethical deliberation on the issue of sex assignment surgery (SAS) for infants with disorders of sex development (DSD) or intersexed as a case study. The main objective of this study is to present a different approach in assessing a biomedical issue within the medium of the Maqasid al-Shari'ah. Within the framework of the maqasidic scheme of benefits and harms, any practice where benefits are substantial is considered permissible, while those promoting harms are prohibited. The concept of Maqasid al-Shari'ah which is the mechanistic interpretation of Qur'an and Hadith presents the holistic attention of Islam on many life activities, including healthcare. Indeed, this concept encompasses many aspects of worldly life, both for the human individual and collectively for the whole society. In healthcare, the practice of SAS on DSD newborns has presented an assortment of implications on the future livelihood of the affected individual. The process of decision-making seems to be very multifaceted since every element such as the determination of the 'correct' sex and the urgency of early surgery must consider the benefits and harms, as well as the child's rights and best interest. The application of the concept of Maqasid al-Shari'ah, would convey a pragmatic approach that is often disregarded in Western medicine. This approach considers the right of the individual to live life optimally, individually and socially and practice his faith, precisely, in accordance with the assigned gender.

Matched MeSH terms: Bioethics; Decision Making/ethics*; Sex Reassignment Surgery/ethics*
Human Embryonic Stem Cell Research: Ethical Views of Buddhist, Hindu and Catholic Leaders in Malaysia

Sivaraman MA, Noor SN

Sci Eng Ethics, 2016 Apr;22(2):467-85.
PMID: 26049934 DOI: 10.1007/s11948-015-9666-9

Embryonic Stem Cell Research (ESCR) raises ethical issues. In the process of research, embryos may be destroyed and, to some, such an act entails the 'killing of human life'. Past studies have sought the views of scientists and the general public on the ethics of ESCR. This study, however, explores multi-faith ethical viewpoints, in particular, those of Buddhists, Hindus and Catholics in Malaysia, on ESCR. Responses were gathered via semi-structured, face-to-face interviews. Three main ethical quandaries emerged from the data: (1) sanctity of life, (2) do no harm, and (3) 'intention' of the research. Concerns regarding the sanctity of life are directed at particular research protocols which interfere with religious notions of human ensoulment and early consciousness. The principle of 'do no harm' which is closely related to ahimsa prohibits all acts of violence. Responses obtained indicate that respondents either discourage research that inflicts harm on living entities or allow ESCR with reservations. 'Intention' of the research seems to be an interesting and viable rationale that would permit ESCR for the Buddhists and Hindus. Research that is intended for the purpose of alleviating human suffering is seen as being ethical. This study also notes that Catholics oppose ESCR on the basis of the inviolability of human life.

Matched MeSH terms: Ethics, Research; Stem Cell Research/ethics*
Fulltext What health management topic frequently appeared in the New England Medical Journal (NEMI)? : a systemic review

Khalib, A.L., Nirmalini, R.

Malaysian Journal of Community Health, 2008;14(2):31-35.
MyJurnal

Introduction : It is no doubt that the success of any health organization depends so closely on its managerial functions. To achieve this, the leader or manager as the core strategist of its organization must in all time be updated with the latest evidence-based information so that he or she can be easily operationalized his or her management function in more effective and sustainable manners. It depends largely on scientific literatures that published relevant articles within this scope. Unfortunately, management topics related to health care system is scattered published and this has indirectly affect manager to access the latest scientific documents.
Methods : We examined the practice of well known international journal in health care namely New England Medical Journal (NEMJ) on its role in propagating latest health management topics to its prospective clients.
Results : The result showed that a total of 31% health management topics were published throughout 2007 out of 1140 articles appeared. Of these, about 33% were confined to general health administration. The remaining articles were related to healthcare delivery practices (24%), medical ethics and legal matters (17% each), and manpower issues and training (9%).
Conclusion : Focus on managerial related articles relatively low as compared to clinical and other evidence-based medicine that clearly dominated health management issues.

Matched MeSH terms: Ethics, Medical

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