Ethical and legal issues in suicide research

Moralist, libertarian and relativist ethical positions concerning suicide and its prevention are presented in order to clarify premises upon which ethical issues in suicide research may be resolved. Ethical concerns are differentiated from legal considerations and the implications of the vulnerability of suicidology research participants are discussed. Specific issues that arise in design, choice of participants, interpretation, diffusion of results and evaluative research are treated. These include: experimental methodologies, obtaining informed consent, deception and disclosure, studying innovative and unproven interventions, unknown consequences of participation, rescue criteria, disclosure of information to third parties, research with special populations, risks in publicizing results and measuring the value of human life. When specific legal obligations are lacking, ethical premises concerning the acceptability of suicide and obligations to intervene may influence research protocols.     

Ethical,legal, social,and policy issues in the use of genomic technology by the U.S. Military

Advances in genomic science are attracting the interest of the U.S. military for their potential to improve medical care for members of the military and to aid in military recruitment, training, specialization, and mission accomplishment. While researchers have explored the ethical, legal, and social issues raised by the use of genomic science in a wide variety of contexts, there has been virtually no examination of these issues in connection with the use of genomics by the military. This article identifies potential uses of genomic science by the military, proposes an applicable ethical and legal framework, and applies the framework to provide ethical and legal guidance for military decision-makers.     

A nation's genes for a cure to cancer: evolving ethical, social and legal issues regarding population genetic databases

The advent of the human genome sequence has focused research on understanding underlying genetic links to complex diseases such as cancer, asthma and heart disease. In the past few years, individual countries, such as Iceland, Estonia, Singapore and the United Kingdom, have created national databases of their citizens' DNA for comparative research. Most recently, an international consortium including Nigeria, Japan, China and the United States launched a $100 million project called the International HapMap to map the human genome according to haplotypes, blocks of DNA that contain genetic variation. Such population genetic databases present challenging ethical, social and legal issues, yet regulation of genetic information has developed sporadically, from region to region, without a consistent international standard. Without a clear understanding of the consequences of genetic research in terms of individual and community-wide discrimination and stigmatization, genetic databases raise concerns about the protection of genetic information. This Note provides a survey of the evolving landscape of population genetic databases as a legislative and public policy tool for national and international regulators. It compares different approaches to regulating the collection and use of population genetic databases in order to understand what areas of consensus are formulating a foundation for an international standard. As the first population genetics project that will span multiple countries for the collection of DNA, the International HapMap has the potential to become an influential standard for the protection of population genetic information. This Note highlights issues among the national databases and the HapMap project that raise ethical, social and legal concerns for the future and recommends further protections for both individual donors and community interests.     

Recent advances in medically assisted conception: legal, ethical and social issues.

A review of reports, bills and legislation from around the world, during the period from 1987 to 1991, reveals certain areas of consensus on the possible or actual, ethical and legal regulation of medically assisted conception. Other areas remain controversial, due not only to cultural and religious differences but also to the social significance of the very implementation of these new technologies. Irrespective of these differences, the reformulation of certain shared international principles of human rights permits a greater specificity both in their translation and in their application to medically assisted conception. Areas discussed include the dignity of the person, the security of human genetic material, the quality of services, the inviolability of the person and the inalienability of the person.     

Choosing between possible lives: legal and ethical issues in preimplantation genetic diagnosis

This article critically appraises the current legal scope of the principal applications of preimplantation genetic diagnosis (PGD). This relatively new technique, which is available to some parents undergoing in vitro fertilization (IVF) treatment, aims to ensure that a child is not born with a seemingly undesirable genetic condition. The question addressed here is whether there should be serious reasons to test for genetic conditions in embryos in order to be able to select between them. The Human Fertilisation and Embryology Authority and the Human Genetics Commission have decided that there should be such reasons by broadly aligning the criteria for PGD with those for selective abortion. This stance is critically explored, as are its implications for the possible use of PGD to select either against or for marginal features or for significant traits. The government is currently reviewing the legal scope and regulation of PGD.     

Ethical, professional and legal regulation of medical practice

Moral or ethical codes of practice represent one of the oldest forms of medical regulation. Legislation such as the Medical Practice Act 1992 (NSW) enables regulatory bodies to create codes of practice for medical practitioners. Such codes can become an important aspect of disciplinary proceedings by providing the yardstick against which practitioners' conduct is evaluated. An important aspect of the New South Wales Board's Code of Professional Conduct 2005 is the obligation for doctors to report adverse events which reflect on the performance or conduct of colleagues. This is part of an increasing impetus to report adverse events in the interest of public safety. In the long- term this is a constructive development as it is likely to lead to improvements in identification of risks and hazards and thereby to result in better service provision and community health.     

Barcelona 2002: law, ethics, and human rights. HIV testing for peacekeeping forces: legal and human rights issues

In 2001, the United Nations Security Council established an Expert Panel to study the issue of whether the UN should institute HIV testing of peacekeeping personnel. This article, based on a 9 July 2002 presentation to the XIV International AIDS Conference (abstract TuOrG1173), reports on the findings of a paper prepared for the Expert Panel by the Canadian HIV/AIDS Legal Network. The paper examined whether it is permissible for the UN to implement mandatory HIV testing of its peacekeeping personnel, and whether HIV-positive UN peacekeeping personnel should be excluded or restricted from service on the basis of their HIV status or HIV disease progression. The article describes some of the court cases in which these issues have been considered; discusses the importance of analyzing such issues in the context of a human rights-based approach to the pandemic; and formulates a series of key principles for guiding UN decision-making. The article concludes that a policy of mandatory HIV testing for all UN peacekeeping personnel cannot be justified on the basis that it is required in order to assess their physical and mental capacity for service; that HIV-positive peacekeeping personnel cannot be excluded from service based on their HIV status alone, but only on their ability to perform their duties; and that the UN cannot resort to mandatory HIV testing for all UN peacekeeping personnel to protect the health and safety of HIV-negative personnel unless it can demonstrate that alternatives to such a policy would not reduce the risk sufficiently. In the end, the Expert Panel unanimously rejected mandatory testing and instead endorsed voluntary HIV counselling and testing for UN peacekeeping personnel.     

Ethical and legal dilemmas surrounding bio-banking

The interaction of medical technology and advancements in human life and biological tissue offers many possibilities and issues, for example the area of assisted conception and the identification and treatment of disease. However, hand-in-hand with these, ethical dilemmas arise. The overarching ethical issue surrounding cryo-preserved embryos is： Should an embryo be accorded the status of ＇life＇ or should it be labeled nothing more than ＇property＇？ This question is the interaction between frozen embryos and divorce, adoption, research and terminal incidents; it is a legal and ethical quagmire that cannot be readily resolved. This issue is of particular moral importance when one contemplates the fact that the scientific definition of life is dealt with on a continuum ranging from the metabolic view to the emergence of self-consciousness. The question must become property versus life or, in essence, sale or destruction of property versus sale or destruction of life. As this paper will show, the underlying attitudes of the progenitors involved in cryogenics can be driven by the darker side of our species; that side being the possible exploitation of those individuals or those capable of becoming individuals for personal and community gain while denying or rationalizing that point of view to society as a whole.     

Hospice utilization: political, cultural, and legal issues

The provision of end-of-life care is considered a substantive part of nursing, and hospice is often considered the "gold standard" of optimal end-of-life care. Unfortunately, however, only an estimated 43% of patients eligible for hospice actually receive hospice services (Harrison, Ford, & Wilson, 2005). The purpose of this article is to describe the political cultural, and legal issues associated with the underutilization of hospice care. Specifically, this article will outline the policy issues for accessing hospice under Medicare and Medicaid, the cultural and social issues in hospice utilization, and the legal implications of these issues. In addition, this article will serve to offer initial solutions to the problems at hand in order to guide nurses in promoting effective, efficient, and realized access to hospice services.