“Poland 2050” Report is a publication of a distinctive sort. While the idea of producingthis report has a long history, it began to take shape about two years ago. It isbased on the two tenets. The first, raised at numerous conferences held in the past underthe auspices of the “Poland 2000 Plus” Committee, is the conviction that economicgrowth does not transpose automatically into societal (or more broadly “civilizational”)advancement. Indeed, the preliminary analysis has indicated that the two processes are,in fact, (...) divergent. While there have been convergent processes evident in Poland’s andthe EU’s economic domains, no such convergence is significantly evident in the case ofsocietal progress. This gave rise to the vision set forth in this Report, formulated as“minimizing Poland’s developmental gap with respect to the more advanced EU states.”The second tenet upon which this Report is based is even more important. Numerousanalyses carried out by the Committee indicate that quantitative changes cannot bepredicted four decades in advance with great likelihood. And so, we did not base ourReport on existing quantitative trends, but rather on analysis of the pathways that willmake it possible to minimize Poland’s developmental gap with respect to the advancedEU states. The Report also strives to highlight threats that exist in the social and “civilizational”sphere.The Report was based on the materials published in the three volumes of the publicationWizja przyszłości Polski – Studia i Analizy [A Vision of Poland’s Future—Studies and Analyses], vol. 1: Społeczeństwo i państwo [Society and State], vol. 2: Gospodarkai środowisko [Economy and Environment], and vol. 3: Ekspertyzy [ExpertStudies]. (shrink)

“Poland 2050” Report is a publication of a distinctive sort. While the idea of producingthis report has a long history, it began to take shape about two years ago. It isbased on the two tenets. The first, raised at numerous conferences held in the past underthe auspices of the “Poland 2000 Plus” Committee, is the conviction that economicgrowth does not transpose automatically into societal (or more broadly “civilizational”)advancement. Indeed, the preliminary analysis has indicated that the two processes are,in fact, (...) divergent. While there have been convergent processes evident in Poland’s andthe EU’s economic domains, no such convergence is significantly evident in the case ofsocietal progress. This gave rise to the vision set forth in this Report, formulated as“minimizing Poland’s developmental gap with respect to the more advanced EU states.”The second tenet upon which this Report is based is even more important. Numerousanalyses carried out by the Committee indicate that quantitative changes cannot bepredicted four decades in advance with great likelihood. And so, we did not base ourReport on existing quantitative trends, but rather on analysis of the pathways that willmake it possible to minimize Poland’s developmental gap with respect to the advancedEU states. The Report also strives to highlight threats that exist in the social and “civilizational”sphere.The Report was based on the materials published in the three volumes of the publicationWizja przyszłości Polski – Studia i Analizy [A Vision of Poland’s Future—Studies and Analyses], vol. 1: Społeczeństwo i państwo [Society and State], vol. 2: Gospodarkai środowisko [Economy and Environment], and vol. 3: Ekspertyzy [ExpertStudies]. (shrink)

This clinical ethics case examines whether healthcare providers have an obligation to inform patients about animal-derived ingredients in medications, specifically focusing on a hospitalized patient who may object to porcine-derived heparin on religious grounds. The ethics committee concluded that healthcare providers have a moral obligation to disclose this information to all patients, not just those presumed to have religious or ethical objections, to allow for informed decision-making. While acknowledging practical challenges around information delivery and increased costs of synthetic (...) alternatives, they recommended developing systematic approaches like information leaflets and staff education to address this issue. The committee emphasized there should be no moral distinction between religious and ethical objections to animal products, and that the healthcare system needs to work with faith and advocacy groups to better serve patients' needs while balancing medical necessity with personal beliefs. (shrink)

This is the fifth of a series of case studies provided and discussed by UK clinical ethics committees. This paper summarises discussion of a case presented by the Central and North West London Foundation NHS Trust Clinical Ethics Committee. The case concerns a 55-year old woman with Alzheimer's disease admitted to a psychiatric hospital following concerns that she was not receiving adequate care at home. Issues discussed include subjective judgements of 'adequate care', deprivation of liberty and (...) assessment of 'best interests'. The case is ethically and legally complex, with multiple stakeholders and a range of options for legal intervention. The Committee's response is provided and a practical solution advised. (shrink)

This clinical ethics case examines whether to continue prescribing Adderall, an unlicensed drug in the UK, to a 30-year-old American patient with uncertain diagnosis who claims benefit from the medication. The ethics committee analyzed key tensions: balancing the patient's preference and reported benefits against diagnostic uncertainty and medical best practices, weighing short-term functioning against long-term risks of an addictive medication, and considering resource allocation implications of prescribing an unlicensed drug. While acknowledging the patient's positive response to Adderall, the (...) committee recommended trying UK-approved medications first while working to establish a clearer diagnosis and building a stronger doctor-patient relationship, rather than simply continuing to prescribe based on patient preference alone. (shrink)

This is the tenth of a series of case studies provided and discussed by UK clinical ethics committees. This paper summarises discussion of a case presented by the Gloucestershire Hospitals NHS Foundation Trust Clinical Ethics Committee. The case concerns a 67-year old woman who presents at the emergency department with chest pain. Her daughter films a resuscitation attempt on her mobile phone. The acceptability of a relative recording a patient's treatment is the focus of this (...) class='Hi'>case study. The committee's discussion and recommendations involve consideration of the interests of the patient, family, and staff, as well as issues of patient autonomy, privacy concerns, and staff well-being. (shrink)

This clinical ethics case examines a complex situation involving a 17-month-old child with multiple serious medical conditions who requires mechanical heart support. The ethics committee grappled with several key issues: whether to relist the child for heart transplant given his poor prognosis and severe neurological impairment, how long to continue mechanical heart support knowing it cannot be a long-term solution, and how to communicate with parents who want "everything done" for their child. The committee recommended against relisting (...) for transplant given the child's poor prognosis and need to fairly allocate scarce organs. However, they advised continuing mechanical support temporarily while working with the parents to establish clear criteria for eventual withdrawal of support and transition to palliative care. They emphasized the need for compassionate, frank discussions with the parents about quality of life and preparing for their child's death, while acknowledging how difficult these conversations will be following their previous loss of a child to similar conditions. (shrink)

This clinical ethics case study examines whether to perform predictive genetic testing on a 5-year-old boy for Li-Fraumeni Syndrome (LFS), a serious cancer predisposition condition identified in his recently deceased father. The consulting ethics committee analyzed key tensions: balancing the mother's desire for testing to manage uncertainty against guidelines favoring delay until the child can participate in decision-making, weighing parental authority versus the child's future autonomy, and addressing professional disagreement between clinical and laboratory teams. While testing may be (...) justified since screening is already underway, the committee recommended thoroughly exploring the mother's reasoning and timing considerations while ensuring good communication and support for all parties involved. (shrink)

This clinical ethics case examines whether to provide a blood transfusion to a severely injured Jehovah's Witness patient who initially agreed to the transfusion but changed her mind after speaking with a friend. The ethics committee analyzed several key issues: how to handle information from friends about a patient's religious beliefs when unconscious, the validity of advance directives, concerns about potential coercion in the patient's change of mind, and how to balance respect for religious beliefs against immediate medical (...) needs. The committee recommended that while unconscious, life-saving treatment should proceed given limited verifiable information about the patient's wishes. Once conscious, if the patient maintains a competent refusal after thorough discussion of risks and consideration of possible coercion, her decision should be respected even if it conflicts with medical recommendations. They emphasized the importance of consulting hospital Jehovah's Witness liaison services and documenting all discussions while exploring non-blood alternatives when possible. (shrink)

This clinical ethics case discusses whether a pregnant paramedic who was bitten by an assailant can compel him to undergo HIV and hepatitis C testing against his will. The ethics committee considered several key issues: balancing the paramedic's right to know her exposure risk against the assailant's right to refuse testing, the special considerations of her pregnancy, and whether healthcare workers deserve additional protections given their occupational risks. While acknowledging the unfairness to the paramedic, the committee concluded (...) that testing without consent would be inappropriate, though they recommended exploring other options like improved communication with the assailant about testing and possible legal avenues. They emphasized that respecting the assailant's refusal does not mean the paramedic's rights are subordinate, but rather reflects the ethical principle that competent individuals can refuse medical interventions. (shrink)

Members of the Student Clinical Ethics Committee discussed the ethical and legal issues arising in a case referred for consideration – the family of a very elderly non-English speaking Asian lady did not want her to be informed that she had incurable lymphoma. The case study summarises the reflections of the Committee and focusses on: the role of cultural norms in healthcare decision making; the extent to which the views of the family about what is best (...) for the patient should be respected, whether the patient should have been informed of her terminal diagnosis and the role of the clinician in navigating complex family dynamics. (shrink)

Members of the Student Clinical Ethics Committee discussed whether tube feeding should be instigated for a man who had indicated through his actions that he may be refusing it, although his family stated that he would have wanted to be kept alive in such a situation. The Committee considered the key issues of capacity and best interests, which in this case were confounded by lack of clarity about whether the patient’s actions amounted to a valid refusal of (...) life sustaining treatment, and if his previous views still pertained to his current, yet unforeseen, circumstances. As the discussion progressed, it became apparent that some members were reluctant to accept that non-insertion of clinically assisted feeding could ever be in a patient’s best interests. (shrink)

Members of the Student Clinical Ethics Committee discussed the ethical issues arising in a case referred for consideration – a homeless man presenting to the emergency department of a busy London hospital with recent self-reported suicide attempts. Should he be admitted overnight in order to address a short-term shelter problem? The case study summarises the reflections of the Committee and focusses on the doctor’s duty of care and patient responsibility, benefits of admission and resource considerations.

Members of the Student Clinical Ethics Committee discussed the ethical and legal issues arising in a case referred for consideration – a female patient in her mid-60s, who had a very long history of multiple sclerosis, withdrew her previous consent to treatment following discussion with her son. The case study summarises the reflections of the Committee and focusses on: the meaning and practical application of respect for patient autonomy; whether a refusal of clinically indicated treatment may (...) challenge the notion of capacity; the role of others in the process of decision-making; if the current decision to refuse treatment was the patient’s own and whether, in the circumstances, it should be respected. (shrink)

The Student Clinical Ethics Committee considered the case of an elderly woman who remained in hospital for 2 months after treatment, despite being considered medically fit for discharge, causing her great distress. The committee considered the justifications for keeping the patient on the ward in order to determine whether she was fit to be discharged to her home. The case study summarises the reflections of the committee and focuses on the capacity of the patient to (...) make the decision to go home, the potential risks and consequences of discharging her, the concerns of the health care teams and their responsibility to make a decision. (shrink)

Background: Ought nursing homes to establish clinical ethics committees (CECs)? An answer to this question must begin with an understanding of how a clinical ethics committee might be beneficial in a nursing home context – to patients, next of kin, professionals, managers, and the institution. With the present article, we aim to contribute to such an understanding. Aim: We ask, in which ways can clinical ethics committees be helpful to stakeholders in a nursing home context? We describe in depth (...) a clinical ethics committee case consultation deemed successful by stakeholders, then reflect on how it was helpful. Research design: Case study using the clinical ethics committee’s written case report and self-evaluation form, and two research interviews, as data. Participants and research context: The nursing home’s ward manager and the patient’s son participated in research interviews. Ethical considerations: Data were collected as part of an implementation study. Clinical ethics committee members and interviewed stakeholders consented to study participation, and also gave specific approval for the publication of the present article. Findings/results: Six different roles played by the clinical ethics committee in the case consultation are described: analyst, advisor, support, moderator, builder of consensus and trust, and disseminator. Discussion: The case study indicates that clinical ethics committees might sometimes be of help to stakeholders in moral challenges in nursing homes. Conclusions: Demanding moral challenges arise in the nursing home setting. More research is needed to examine whether clinical ethics committees might be suitable as ethics support structures in nursing homes and community care. (shrink)

This paper argues that the function of moral education in the biomedical context should be exactly the same as in a general, philosophical framework: it should not provide ready-to-use kits of moral principles; rather, it must show the history, epistemology and conceptual structure of moral theories that would enable those who have to make decisions to be as informed and as responsible as possible. If this complexity cannot be attained, an incomplete product—i.e. bioethics or bioethical principles—should not be seen as (...) a viable substitute. This theoretical position is subsequently illustrated by a case study involving research ethics committees. It is argued that within these committees, that are carefully formed multidisciplinary bodies, what makes competent decision-making possible is not a bioethical theory, nor even a sound philosophical ethics, but the dynamics of the discussion of a number of experts coming from different disciplines. This multidisciplinary expertise is necessary and sufficient to undertake the challenges of complex decisions in the biomedical context. (shrink)

Medical ethics committees are increasingly called on to assist doctors, patients, and families in resolving difficult ethics issues. Although committees are becoming more sophisticated in the substance of medical ethics, little attention has been given to the processes these committees use to facilitate decision-making. In 1990, the National Institute for Dispute Resolution in Washington, D.C., provided a planning grant from its Innovation Fund to the Institute of Public Law of the University of New Mexico School of Law to look at (...) what ethics committees can learn from facilitation and mediation techniques. The study's thesis was that, if adapted for use by medical ethics committees, facilitation and mediation techniques can be helpful to those bodies in case review consultations and in other internal committee processes. This article reports on that project. (shrink)

Background: Clinical ethics consultation services have been established in many countries during recent decades. An important task is to discuss concrete clinical cases. However, empirical research observing what is happening during such deliberations is scarce. Objectives: To explore clinical ethics committees’ deliberations and to identify areas for improvement. Design: A pilot study including observations of committees deliberating a paper case, semistructured group interviews, and qualitative analysis of the data. Participants: Nine hospital ethics committees in Norway. Results and interpretations: Key (...) elements of the deliberations included identifying the ethical problems; exploring moral values and principles; clarifying key concepts and relevant legal regulation; exploring medical facts, the patient’s situation, the therapists’ perspective, analogous clinical situations, professional uncertainties, the patient’s and relatives’ perspective, and clinical communication; identifying the involved parties and how to involve them; identifying possible courses of action, and possible conclusion and follow-up. The various elements were closely interwoven. The content and conclusions varied and seemed to be contingent on the committee members’ interpretations, experience and knowledge. Important aspects of a clinical ethics deliberation were sometimes neglected. When the committees used a deliberation procedure and a blackboard, the deliberations tended to become more systematic and transparent. Many of the committees were insecure about how to include the involved parties and how to document the deliberations. Conclusion: Clinical ethics committees may provide an important arena for multidisciplinary discussions of complex clinical ethics challenges. However, this seems to require adequate composition, adoption of transparent deliberation procedures, and targeted training. (shrink)

Background Although the research should guarantee the protection of privacy and personal data, case reports and case series frequently lack the involvement of the ethics board and informed consent that includes the required information. This study aimed to analyze the reporting about informed consent and ethics committees in case reports and case series. Methods This cross-sectional meta-research study analyzed case reports and case series published in 2021, indexed in PubMed, and available as open-access articles. (...) Extracted variables included authorship details, country, journal name, number of cases, and documentation of informed consent and ethics committee approval. Results This study analyzed 2053 case reports and case series. Most articles (86%) reported a single case. Statements about informed consent were reported in 79% of cases. Informed consent was primarily obtained from patients (74%). Statements about an ethics committee were reported in 46% of articles. In 24% of articles, it was reported that approval was obtained from an ethics committee. Case reports were significantly more likely to include a statement on informed consent than case series. On the contrary, case series were significantly more likely to report ethics committee statements than case reports. Conclusion The findings reveal inconsistencies in ethics reporting, with 46% of articles mentioning ethics committee involvement and varying justifications for exemption. While 79% of articles reported informed consent, further improvements in transparency and standardization are needed. Clear guidelines on ethical approval requirements and consent documentation should be established to enhance the quality and ethical rigor of case reports. (shrink)

This research focuses on how research ethics committee and integrity board members discuss and decide on solutions to case scenarios that involve a dimension of research ethics or integrity in collaborative settings. The cases involved issues around authorship, conflict of interest, disregard of good scientific practice and ethics review, and research with vulnerable populations (children and neonates). The cases were set in a university, a hospital, or a research institute. In the research, we used a deductive qualitative approach (...) with thematic analysis. Twenty-seven research ethics committee and research integrity board members from 16 European countries and one country outside Europe participated. Participants represented natural and life sciences, social sciences, and humanities. They worked on cases involving ethical/integrity issues in six different constellations. Results show that experts apply key elements of ethical decision making, namely identification of ethical issues, stakeholders, guidelines, solutions, and own positionality, in dealing collaboratively with ethics/ integrity problems, and the nature of the application depends on the complexity of the case. Understanding how individuals knowledgeable in research ethics and integrity, in this case, individuals serving on research ethics committees and integrity boards, approach ethical/ moral issues can help to identify strategies that may be useful in the development of research ethics and integrity training for junior researchers who may benefit from learning professional strategies. (shrink)

The first section of this paper asks why the notion of consensus has recently come to the fore in the medical humanities, and suggests that the answer is a function of growing technological and professional complexity. The next two sections examine the concept of consensus analytically, citing some of the recent philosophical literature. The fourth section looks at committee deliberations and their desirable outcomes, and questions the degree to which consensus serves those outcomes. In the fifth and last section (...) it is suggested that if I am to subscribe to a consensual outcome responsibly I must be personally committed to it, and that this requires a form of knowledge I call ‘fiduciary’, in this case knowledge of the competence and trustworthiness of other participants in deliberation whose expertise may have influenced my agreement. (shrink)

Since Clinical Ethics Consultation has become important in the public health sector in the last decade in Germany, there are on-going questions about effectiveness. Targets have been established by the Ethics Committees, in regard to assisting patients, families and health care teams at times of ethical conflicts during the decision-making process in medical care. Of all the ethics consultations over the last eight years at Erlangen University Hospital the consultations carried out in the pediatric department were chosen to be reviewed (...) by a pediatrician and an ethicist. These were evaluated on the basis of team formation, interdisciplinary orientation, ethical criteria, completeness and methods of documentation. Results of the analysis of those records show a well-organized consultation team with regard to its personnel composition. Discrepancies with ethical questions posed in the literature are revealed, and also some partially incomplete documentation regarding medical facts and descriptions of the patients' or parents' opinion. (shrink)

If ethics consultation services influence medical decisions it is important to evaluate how ethical dilemmas are dealt with by clinical ethics committees (CECs). Such evaluation is rare. This study presents a feasible and practical method of evaluating case discussions in CECs and the results emerging from the use of this method. A written presentation of an end-of-life dilemma was sent to all Norwegian ethics committees. The committees were asked to deal with the case as they would do if (...) it was a real case, and to prepare a written report of the discussion. A majority of the committees approached the case systematically. All emphasized the importance of good communication with the next of kin. However, their conclusions varied, medical facts were interpreted differently, possible patient suffering was dealt with differently, and some committees revealed insufficient legal knowledge. Such findings are useful in the future education of committee members. (shrink)

In this paper we discuss differing discourses of research ethics committees and the clinical research field. Reflections on our experience of conducting research in a nursing home are used to highlight the tensions and inconsistencies that arise from these discourses and the need to behave ethically in the field. While accepting the need for adherence to guiding principles of duty based ethics, we have found that practical moral decisions in the field required that, as individual researchers, we needed to exercise (...) discretionary judgement, informed by the ethic of care and the concern for the well‐being of research participants. (shrink)

A dichotomous decision-making context in committees is considered where potential partisan members with predetermined votes can generate inefficient decisions and buy neutral votes. The optimal voting rule minimizing the expected costs of inefficient decisions for the case of a three-member committee is analyzed. It is shown that the optimal voting rule can be non-monotonic with respect to side-transfers: in the symmetric case, majority voting is optimal under either zero, mild or full side-transfer possibilities, whereas unanimity voting may (...) be optimal under an intermediate side-transfer possibility. The side-transfer possibilities depend on the power of partisans (their ability or willingness to pay for neutral votes) relative to the corruptibility of neutral members (personal cost of deliberately casting a `wrong' vote). (shrink)