Asunto(s)

RESUMEN

This article presents and evaluates 105 project proposals submitted for review by a regional committee for medical research ethics in Norway from 1987 to 1997. The committee's review practice is presented in a historical and international perspective. Until recently, no serious objections seem to have been raised to the suitability of children as research subjects. Abuse of children in research has been uncovered; as a result, strict criteria for including children in research have been developed. Our regional research ethics committee has reviewed project proposals on this background. Over a ten-year period the regional committee reviewed 105 project proposals with children as subjects, advising against implementation in only nine cases. Most projects were approved with changes. 16 approved projects were invasive and non-therapeutic. We present the committee's reasons for allowing research on children and discuss some pertinent problems in research ethics. Recently it has been shown that protective caution excludes children from research. As a result, medical services for children are not of the same quality as those for adults. There is a need for a change of practice towards including children in research unless there are scientific or ethical reasons to exclude them. The new guidelines of the National Institutes of Health attest to this change.

Asunto(s)

RESUMEN

Health care ethics committees are now established at three hospitals in Norway as a result of a three year project in cooperation with the Centre for Medical Ethics and the Ministry of Health and Social Affairs. This article describes the project and discusses various difficulties regarding the establishment and functioning of health care ethics committees, such as their mandate and membership, the understanding of ethics and methodology, the role of ethical expertise and the relation between physicians' decision-making responsibility and a health care ethics committee.

Asunto(s)

RESUMEN

50 years ago, in Nuremberg, 23 German doctors were accused of crimes against humanity. The anniversary is a solemn reminder of the dark origins of medical research ethics. Many researchers today believe that the medical experiments carried out under Hitler "vaccinated" postwar researchers against abuse. A review of the practices of postwar research shows that the "vaccination" had limited effect and that there is no reason to believe that the events which took place under Hitler were unique and will never happen again. After the war various measures were introduced to protect research subjects: informed consent, self regulation and independent research ethics committees. The measures have undoubtedly limited the abuse of subjects substantially. Nevertheless, in the Armed Forces, where abuse has been most rampant after the war, informed consent is not always practised and independent review is seldom carried out. With the support of grant institutions, journals and industry the protection of research subjects can be improved. It is recommended that medical faculties arrange an annual commemoration of the victims of medical research in order to raise consciousness and awareness among teachers and students.

Asunto(s)

RESUMEN

Who should be offered medically assisted conception treatment within a public health care system? This article discusses medical and ethical selection criteria in relation to general political guidelines for prioritization. Our tentative conclusion is that it is possible to differentiate between groups of patients according to disease criteria, the severity of disease, medical efficacy and cost-efficiency. We note that there is a great need for data to enable well-founded decisions when prioritizing applicants for in vitro fertilization within a public health care system.

Asunto(s)

RESUMEN

This article is an attempt to evaluate the Oregon plan from the perspective of a Scandinavian national health care system. The Nordic welfare states are marked by a strong emphasis on equality. As an example of an egalitarian system we present the Norwegian health care model in part one. In part two, the arguments in favor of a one tier system in Norway are presented and compared to Oregon's two tier system. Although we argue, in part three, that a comparison of the degree of explicitness in the prioritization process shows that Norway has much to learn from Oregon, we do believe that the Norwegian system has some attractive elements that may function as an important corrective. In part four we present the Norwegian Guidelines for priority-setting and discuss the weight assigned to the severity of disease criterion. It is argued that the exclusion of information about the severity of disease partly explains the counterintuitive ranking of treatment-condition pairs in Oregon's initial method based on the principle of health maximization. A normative analysis of the conflicting norms of efficiency and equality of results is called for. The final part of the paper is devoted to the problem of rigidity. Henry J. Aaron has argued that the Oregon system is insensitive to inter-individual variations within each diagnosis-treatment pair. This objection is a severe one, since the system might end up treating patients unfairly on the individual level. To overcome this problem, we suggest a selection rule that should be more capable of dealing with the problem of rigidity.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

There is great uncertainty and concern about the reliability of success rates in IVF. This is because of lack of agreement about what defines success and how this should be measured. Success should be reported on the basis of real birth rates measured against all stimulation cycles and all women accepted for treatment. This is because the purpose of IVF is to alleviate infertility, and couples (or women) who seek treatment will only consider live birth as a successful result. All clinics should be required to submit these results to a national registry in order to retain accreditation by the Ministry of Health. The purpose of the registry is to make information available to couples (or women) about their real chances of giving birth to a child. This will also make it possible to evaluate whether the economic resources are used efficiently, a requirement which may help to standardize the definition of success used in medical journals.

Asunto(s)

RESUMEN

The authors present the state of Oregon's recent proposal for prioritizing the health services. We suggest that the proposal involves certain problems, and suggest alternative methods of making priorities. It is also pointed out, however, that there may be certain lessons to be learned from this proposal in terms of the method used to obtain a prioritized list of health care services.

Asunto(s)