We do not know how much clinical physicians carrying out clinical trials in oncology and haematology struggle with ethical concerns. To our knowledge, no empirical research exists on these questions in a Nordic context. Therefore, this study aims to learn what kinds of ethical challenges physicians in Sweden, Denmark and Finland (n = 29) face when caring for patients in clinical trials; and what strategies, if any, they have developed to deal with them. The main findings were that clinical cancer trials pose ethical challenges related to autonomy issues, unreasonable hope for benefits and the therapeutic misconception. Nevertheless, some physicians expressed that struggling with such challenges was not of great concern. This conveys a culture of hope where health care professionals and patients uphold hope and mutually support belief in clinical trials. This culture being implicit, physicians need opportunities to deliberately reflect over the characteristics that should constitute this culture.

Central to ethical debates in contemporary mental health research are the rhetoric of parity of esteem, challenges underpinned by the social construct of vulnerability and the tendency to homogenise the population diagnosed with mental health conditions. Such ethical dimensions are further complicated by the contemporary endeavour to work with ‘big data’ which has led to ambitious claims for discovery and knowledge. Research in mental health is challenging due to the perceived constraints of ethical principles such as the protection of autonomy, consent, risk and harms. This article discusses how ethical considerations need to be reconceptualised when using big data sets. The argument is foregrounded with an appraisal of the prevailing political discourse of parity of esteem demonstrating that ongoing disparities in services and research should also be considered when inquiry uses big data.

Clinical ethics consultation service remains undeveloped in developing countries. It is recognised that its introduction poses challenges. Malaysia, a multicultural society with diverse religions, values and perceptions further complicate the introduction of formal clinical ethics consultation service. Clinicians attending a national congress workshop completed a Strengths–Weaknesses–Opportunities–Threats analysis. The aim was to gain insight into clinician’s expectations and promote initiatives leading to the introduction of clinical ethics consultation service. Clinicians agree that clinical ethics consultation service can improve quality of care, reduce healthcare costs and advocate for patients and providers. The analysis highlighted constraints in sufficient critical mass of relevant expertise and restricted opportunities for training. The opportunities lie in education, curriculum development and availability of dedicated proponents. Cultural barriers, limited resources, lack of awareness, differences in opinions, fear of litigation and destructive influence of social media are seen as threats to the introduction of clinical ethics consultation service. This study illustrates the value of involving stakeholders when introducing clinical ethics consultation service formally. The issues identified will inform the strategic directions for the delivery of clinical ethics consultation service at a national level.

It is commonly assumed that there are differences in physicians’ and caregivers’ ethical attitudes towards clinical situations. The assumption is that the difference is driven by different values, views and judgements in specific situations. At Aalborg University Hospital, Denmark, we aimed to investigate these assumptions by conducting a large quantitative study. The study design, based on the Factorial Survey Method, was a carefully constructed survey with 50 questions designed to test which factors influenced the respondents’ ethical reasoning. The factors were clustered into three categories of ethical reasoning and values. The categories were formulated in terms of easily recognizable ethical positions: consequential ethics, deontological ethics and relational ethics. Based on 2129 respondents, we found significant support for the assumption of differences between physicians and caregivers. The group of caregivers favoured the relational ethics view in clinical ethical situations, and the group of physicians favoured the position of deontological ethics.

Introduction There is a significant disparity in the United States between the health care received by children with special health care needs versus physically healthy children. Objective The objective of the paper is to show that children with special needs receive less than adequate health care overall. This disparity affects the quality of life for these children and influences their ability to live their lives to their full potential. Methods Research was conducted by examining multiple studies with a focus on six major factors that play a role in creating this disparity. Results The findings show an alarming trend in the access and delivery of health care to children with special health care needs. Conclusions Solutions to correcting the disparities are possible, but it will take a full understanding of the issues, perseverance, dedication, and hard work on the part of families, physicians, legislators, and others genuinely interested in creating an equal health care system for all children.

Harm minimisation has been proposed as a means of supporting people who self-injure. When adopting this approach, rather than trying to stop self-injury immediately the person is allowed to injure safely whilst developing more appropriate ways of dealing with distress. The approach is controversial as the health care professional actively allows harm to occur. This paper will consider a specific objection to harm minimisation. That is, it is a misguided collaboration between the health care professional and the person who self-injures that is morally and clinically questionable. The objection has two components. The first component is moral in nature and asserts that the health care professional is complicit in any harm that occurs and as a result they can be held morally responsible and subject to moral blame. The second component is clinical in nature and suggests that harm minimisation involves the health care professional in colluding in the perpetuation of self-injury. This element of the objection is based on a psychodynamic understanding of why self-injury occurs and it is argued that harm minimisation is merely a mechanism for avoiding thinking about the psychotherapeutic issues that need to be addressed. Thus, the health care professional merely reinforces a dysfunctional pattern of behaviour and supports the perpetuation of self-injury. I will consider this objection and argue that it fails on both counts. I conclude that the use of harm minimisation techniques is an appropriate form of intervention that is helpful to certain individuals in some situations.

Debate persists over the place of conscience in medicine. Some argue for the complete exclusion of conscientious objection, while others claim an absolute right of refusal. This paper proposes that claims of conscientious objection can and should be permitted if they concern kinds of actions which fall outside of the normative standard of medicine, which is the pursuit of health. Medical practice which meets this criterion we call medicine qua medicine. If conscientious refusal concerns something consonant with the health-restoring aims of medicine, it entails a desertion of professional duty. If, however, it relates to something other than medicine qua medicine, it can rightly be refused. It thus becomes possible to test instances of conscientious objection to determine their validity, and thereby conserve both the principle of conscientious objection and define its scope. This test of conscience prevents arbitrary discrimination, and preserves doctors’ agency. It is a theoretical razor rooted in the practical reasoning of medicine whose operation will prompt, if nothing else, reflection on the goals of medicine.

BackgroundThe complexity of decision-making in the paediatric context is well recognised. In the majority of cases, parents and healthcare professionals work together to decide which treatments the...

Moral case deliberation is one form of clinical ethics support, and there seems to be different ways of facilitating thedialogue. This paper aimed to explore the personal experiences of Swedish fac ...