Bioethics, Medical Ethics and Health Law: Program and Book of Abstracts

UNESCO Chair in Bioethics 10th World Conference on
Bioethics, Medical Ethics

and Health Law
Zefat Bioethics Forum
Program and Book of Abstracts

Crowne Plaza Hotel
Jerusalem, Israel
January 6-8, 2015
ISAS International Seminars • POB 574, Jerusalem, Israel • Tel: +972-2-6520574

seminars@isas.co.il • www.bioethics-conferences.com
Program at a Glance
Tuesday, January 6, 2015
HALL A HALL B HALL C HALL D HALL E
0900‐1030 Bioethics: General (1) Medical Ethics Ethics: General (1) Psychiatry, Ethics Medical Law (1)
and Law
1030‐1100 Coffee Break
1100‐1230 Opening Session
1230‐1330 Lunch Break
1330‐1500 Bioethics: General (2) Military Medical Ethics: General (2) Research (1) Medical Law (2)
Ethics
1500‐1630 Bioethics: General (3) Military Law and Ethics: General (3) Research (2) Medical Law (3)
Ethics
1700‐1830 Bioethics: General (4)Ethical and Legal Ethics: General (4) Research (3) Medical Law (4)
Issues in Medical
Rehabilitation
1900 Welcome cocktail and Get‐together dinner
Wednesday, January 7, 2015
0900‐1030 Bioethics: General (5) Bioethics: Education (1) Ethics: General (5) Ethics and Regulation Psychology, Ethics
of Inter‐Country and Law
Medically Assisted
Reproduction (1)
1100‐1230 Bioethics: General (6) Bioethics: Education (2) Ethics: General (6) Ethics and Regulation Emotional
of Inter‐Country Intelligence and
Medically Assisted Ethics for Effective
Reproduction (2) Treatment
1330‐1500 Bioethics: General (7) Bioethics: Education (3) Ethics: General (7) Ethics and Issues in Psychology,
Regulation of Inter‐ Law and Ethics in
Country Medically Israel
Assisted
Reproduction (3)
1500‐1630 Bioethics: General (8) Bioethics: Education (4) Hunger Strike of Ethics and Technology
Prisoners Regulation of Inter‐ Dependent Children:
Country Medically The Implication on
Assisted Longevity and Quality
Reproduction (4) of Life
1700‐1830 Bioethics: General (9) Bioethics: Education (5) End of Life (1) Assisted Medical Law (5)
Reproduction (1)
1930 Gala farewell dinner and folkore evening
Thursday, January 8, 2015
0900‐1030 Medical Law (6) End of Life (2) Bioethics: General (10) Assisted (1) ‫מושב בעברית‬
Reproduction (2)
1100‐1230 Medical Law (7) End of Life (3) ‫מושב דיאטניות‬ ‫ועדות אתיקה‬ (2) ‫מושב בעברית‬ - ‫תקשורת אנושית‬
‫במערכת הבריאות‬ ‫ רגש והתנהגות‬,‫מוח‬
‫ אתגרים‬:‫בישראל‬ ‫)אינטליגנציה רגשית‬
‫והצלחות – ניסיון‬ (‫והיבטים אתיים‬
‫מהשטח‬
1330‐1500 Ethics of Mental Gnawing Ethical Ethics Dilemmas in ‫ מקומם של בני‬: ‫סדנה‬ (3) ‫מושב בעברית‬
First Aid & First Aid Conundra Pain ‫המשפחה בתהליך הדיון‬
Organizations ‫האתי‬
TABLE OF CONTENTS
UNESCO Chair in Bioethics, Unit Heads, Departments and Sponsors 4
Message from the Conference President 5
Call for Establishment of New Bioethics Units 6
General Information 7
UNESCO Chair in Bioethics – International Forum of Teachers 8
Scientific Program 10
Abstracts (alphabetical order by author)
Oral Presentations 17
Hebrew Presentations 81
Poster Presentations 87
Authors Index 93
UNESCO Chair in Bioethics
Prof. Carmi Amnon, President
Organizing Committee Scientific Committee

Dr. Blachar Yoram, Chair Prof. Linn Shai, Chair
Dr. Atrakchi Dalit Prof. Ashkenazi Shai
Dr. Avnad Yitzchak Prof. Bitterman Haim
Mrs. Cohen Ilana Dr. Blackmar Jeff
Prof. D’Sousa Russell Dr. Hildesheimer Galya
Dr. Eidelman Leonid Dr. Hirschfeld Miriam
Prof. Kaplan Ruth Prof. Kaplan Ruth
Dr. Kloiber Otmar Prof. Kasher Asa
Prof. Knobler Haim Dr. Kaufman Galit
Mr. Kovachev Bogdan Prof. Kitaee Eliezer
Prof. Noguchi Thomas Prof. Knobler Haim
Dr. Vasinova Miroslava Dr. Mungherera Margaret
Prof. Porath Avi
Adv. Seebholm Annabel
Prof. Steinberg Avraham
Ms. Suipyte Jorune
Prof. Tabak Nili
Dr. Wagner Nurit
Adv. Wapner Leah
Dr. Weiss Dorit
Heads of Units
Albania: Dr. Altin Stafa India West: Prof. Anu Kant Mital
Argentina: Prof. Moty Benyakar Indonesia: Prof. Siti Pariani
Armenia: Dr. Susanna Davtyan Israel: Prof. Shai Linn, Prof. Michael Tal
Australia: Dr. Irina Pollard Italy: Dr. Miroslava Vasinova
Austria: Prof. Gabriele Werner Felmayer Japan: Prof. Mitsuyashu Kurosu
Azerbaijan: Prof. Vugar Mammadov Macedonia: Prof. Mentor Hamiti
Brazil: Prof. Jose Thome Malaysia: Prof. Dato Mohd Zin bin Bidin
Bulgaria: Prof. Sashka Popova Nepal: Prof. Dr. Rupa Rajbhandari Singh
Canada: Prof. Joel Lamoure Nigeria: Dr. Victoria Nanben Omole
China: Prof. Zhen Li Pakistan: Prof. Rizwan Taj
Colombia: Prof. Andrea Hellemeyer, Philippines: Dr. Rhodora C. Estacio,
Prof. Gina Lorena Garcia Martinez Prof. Agnes D. Mejia
Croatia: Prof. Suncana Roksandic Vidlicka Poland: Prof. Joanna Rozynska,
Czech Republic: Prof. Tomas Dolezal Prof. Anna Alichniewicz, Prof. Monika Michalowska
Fiji: Ms. Sharon Biribo Romania: Prof. Sandu Frunza
Finland: Dr. Helena Siipi Russian Federation:
France: Prof. Frederique Claudot St. Petersburg: Dr. Galina Mirtikichan
Germany: Prof. Dr. Nils Hoppe Volgograd: Prof. Natalia Sedova
India: Prof. Dinesan N., Dr. Junaid Rahman, Serbia: Prof. Vojin Rakic
Prof. Dr. P. Thangaraju, Dr. D. Balakrishnan South Africa: Adj. Prof. Ames Dhai
India, Calicut: Dr. C. Raveendran, Spain: Prof. Julian Valero-Torrijos,
Dr. Jayakrishnan Thavody Prof. Maria Magnolia Pardo-Lopez
India, Central New Delhi: Dr. Smita N. Deshpande Sri Lanka: Dr. Harischandra Gambheera
India, Gujarat: Dr. Barna Ganguly Taiwan: Prof. Daniel Fu-Chang Tsai
India, Mangalore: Dr. Animesh Jain Ukraine: Dr. Radmila Hrevtsova
India, Manipal: Dr. Mary Mathew USA: Dr. Harold J. Bursztajn, Dr. Terry Bard
India North: Prof. Mushtaq Margoob, Vietnam: Prof. Nguyen Duc Hinh,
Prof. Rafiq Ahmad Pampori Dr. Tran Thi Thanh Huong
India South: Dr. Princy Louis Palaty Asia Pacific Bioethics Network:
India, Tamilnadu: Dr. Kuryan George Prof. Russell D’Souza

4
MESSAGE FROM THE CONFERENCE PRESIDENT
For the first fifty years of bioethics we discussed the construction and development of its concept.
The original idea slowly gained its directions and followers, and constitutes a comprehensive
perception concerning many issues that are critical for our human society. We are now facing a
second stage, a new task, that seems to be even more important, complex and difficult, namely
the delivering of our message to society, by planting the ethical values into the soul of the people
and into their daily life and behavior.
Our task may be and should be realized in two ways, by two different tools: An educational tool
and a legal tool. The educational tool will consist of the use of novel methods that will enable us
access to the minds of potential “consumers” – the students, the caretakers, the patients and the
public at large. The theory and language of bioethics should be translated and adopted by the
legislator and the judiciary, and constitute the legal tool.
A concrete example can be found in the Universal Declaration of Bioethics and Human Rights of
UNESCO, and its application by the UNESCO Chair in Bioethics. The UNESCO Declaration includes 15
ethical principles that have been approved and accepted by all the states worldwide. Our UNESO
Chair in Bioethics was authorized to deliver the message of the Declaration to the students all over
the world. The first step has been made. We have published ten guidance books for teachers and
have established not less than 51 Units in 42 academic institutes on five continents. Each Unit is
committed to the advancement of ethics education in its university and around its country.
The experts that attend our conference in Jerusalem are expected to undertake this mission, to
start the second step and to establish additional units in their own institutes. You have the
knowledge and the close contact to the field of bioethics, you understand its relevance and
importance, you have the tools, the wisdom and the courage to motivate this process.
Let the Conference in Jerusalem function and serve as the bioethical lighthouse for the next
generation.
Prof. Amnon Carmi

Zefat Academic College
5
The UNESCO Chair in Bioethics promotes
A Call for the Establishment

of New Bioethics Units
You are invited to establish a new UNIT at your Institute!
The United Nations Educational Scientific and Cultural
Organization (UNESCO) established (2001) the

The purpose of the CHAIR is to build, activate, co-ordinate and
stimulate an International Network of Units in Academic
institutes for ethics education.
The Chair has established until now 51 Units in 42 countries in
the five Continents.
If you wish to establish a new UNESCO Unit in your own institute
you may forward your application to:
amnoncarmi@gmail.com
For more details, guidelines and list of other Units, see:
www.unesco-chair-bioethics.org

6
GENERAL INFORMATION
Conference Venue:
Jerusalem Crowne Plaza Hotel
Givat Ram, Jerusalem
Telephone: +972‐2‐6588888

Information Desk:
Jerusalem Crowne Plaza Hotel Lobby
Early registration: January 5, 2015 – 17:00‐19:00
January 6‐8 – during conference hours

Press Office:
Dr. Giacomo Sado, +39 335 57 89671 or at the conference information desk

Social Events:
Welcome get‐together cocktail and dinner
Tuesday, January 6, 2015
Jerusalem Crowne Plaza Hotel ‐ 19:30
Price: $65

Gala farewell dinner and folklore evening
Wednesday, January 7, 2015
Jerusalem Crowne Plaza Hotel ‐ 19:30
Price: $70

Performing in the hotel ballroom after the gala dinner will be the Jerusalem Folklore Ensemble – founded in 1955 in
Jerusalem by students of the Hebrew University, the Rubin Music Academy and Bezalel School of Arts. Today it is one of
Israel’s leading Folklore groups. The ensemble is a voluntary nonprofit organization.
The program is a selection of dances, songs and melodies of Israel and Jewish Folklore. The show features ethnic folklore
of Jewish communities from Yemen, Persia, Turkey, North Africa, The Balkans, Romania, Poland and Russia.
The group took part in many Folklore Festivals in Asia, Africa, Europe and the Americas. It has gained many international
prizes and medals (such as “Le Collier D’or” Dijon, France).

Accompanying Persons: Accompanying persons do not have entry to lecture halls. The registration fee includes the
welcome get‐together cocktail and dinner and the gala farewell dinner and folklore evening.

Tours and Hotel Accommodations: For tours, please contact Eran Brill at 03‐516‐6699. For hotels, please contact Atar
Krauss at 052‐243‐0025; or contact the hospitality desk on January 6.

Certificate of Participation: A certificate of participation will be supplied upon request.

Access to lecture rooms: Your registration fee includes entry to sessions, conference program and book of abstracts, and
coffee breaks. Seating is on a “first‐come, first‐served” basis. We recommend you go to the lecture room well before the
session starts. Safety regulations require us to limit access to the session if the room is filled to capacity. A sweater or
jacket is recommended, as the conference rooms may be cool.

Name badges: Your personal name badge serves as your passport to the scientific sessions. Participants are expected to
wear their badges visibly at all times.
No badge = no entry. Badge replacement costs $25.

Poster presentations should be put up in the lobby area from 08:00‐09:00 on the morning of presentation. A hostess will
be available to help attach the posters each morning until 10:00. Posters must be removed at the end of the day. The
Organizers will not be responsible for posters that have not been collected.

Note: ISAS International Seminars and all sponsors shall not be responsible for and shall be exempt from any liability in
respect of any loss, damage, injury, accident, delay or inconvenience to any person, or luggage or any other property for
any reason whatsoever, for any tourist services provided. Personal travel and health insurance is recommended.

Conference Secretariat:
ISAS International Seminars • POB 574, Jerusalem 91004, Israel • Tel: +972‐2‐6520574
seminars@isas.co.il • www.bioethics‐conferences.com
7

International Forum of Teachers
Statutes

The Steering Committee of the International Network of the UNESCO Chair in Bioethics discussed, decided
and announced the establishment of the Chair's International Forum of Teachers in its Annual Meeting
that was held on the 18 November, 2013, in Naples, Italy.

Article 1: The Forum
a. The International Forum of Teachers (referred to hereinafter as the "IFT") will be part of the Education
Department of the International Network of the UNESCO Chair in Bioethics.
b. IFT will consist of teachers that have been admitted pursuant to the requirements of these Statutes.
c. English is the working language of IFT.
d. The office of IFT shall be located in the country of residence of the Director.

Article 2: Aims
a. The aim of the IFT is to form and activate an organ that will function as a mechanism for the realization of the
objectives and activities of the IFT.
b. To collect, unite, involve and activate teachers of bioethics, ethics and medical law.
c. To promote and advance the study, discussion and teaching of bioethics, ethics and medical law.
d. To address any matters that involve issues of bioethics, ethics or medical law.

Article 3: Activities
The IFT will pursue its aims by, inter alia:
a. Promoting and advancing synergies and co‐operation among its members;
b. Facilitating exchange of experience and information of programs and projects;
c. Developing and distributing educational programs and materials;
d. Initiating and organizing meetings;
e. Initiating and organizing courses and seminars;
f. Initiating and encouraging compilation, publication and translation of professional materials;
g. Establishing committees to deal with specific issues;
h. Pursuing other means harmonious with the aims of IFT.

Article 4: Membership
a. Membership of IFT shall be open to all who have graduated from a university or equivalent academic institution,
who are or were involved in teaching of bioethics, ethics or medical law, and who are interested in the
fulfillment of the aims of IFT.
b. An application for membership + a CV shall be addressed to the Director. The Director will verify that the
application complies with Article 4(a) and will refer it to the President.
c. The decision to admit a teacher to the IFT is made by the President and the Director.
d. The refusal of membership shall be decided by the Council.
e. The Steering Committee is entitled to bestow honorary membership.
f. The Steering Committee is entitled to bestow Senior Membership titles.
g. Membership shall terminate upon resignation, expulsion decided by the Council or death.
h. A register of membership shall be kept under the authority of the Director.
i. Members of the IFT shall be entitled, inter alia, to:
1. Attend and vote in person at the Assembly;
2. Stand for election to the Council;
3. Be appointed to IFT committees;
4. Enjoy specific benefits, rights and reduced fees available only to members of the IFT
j. The Assembly is entitled to decide about the imposition of dues.

8

Article 5: Structure
The organs of the IFT shall be the Assembly, the Council, the President, the Director, the Steering Committee and
the committees.

Article 6: The Assembly
a. The Assembly shall be made up of currently members of the IFT. Each member shall have one vote. A member's
vote shall be cast only in person.
b. Extraordinary meetings of the Assembly may be convened by the Council or the Steering Committee.
c. The Assembly shall meet ordinarily on the occasion of the world congress of the Chair.
d. The agenda of the Assembly shall include the reports of the President, the Director, and the Chairperson of the
Council, the election of the President, the Director, the members of the Council and the Steering Committee.
The agenda will include the determination of membership dues and additional issues as proposed by a member
of the Steering Committee.
e. All decisions from the Assembly will be made with absolute majority of the valid votes. The President has a
casting vote.

Article 7: The Council
a. The Council shall consist of not more than thirty members.
b. The Assembly shall elect members of the Council for a two‐year period. Members of the Council shall be eligible
for no more than two successive re‐elections.
c. Candidatures for the Council shall be addressed to the Director at least three months before the
commencement of the next world congress.
d. The Council will prepare the Assembly. The Council will carry out the resolutions of the Assembly. The Council
will develop activities with a view to realizing the IFT's aims.
e. The Council may delegate any of its powers to the Steering Committee.

Article 8: The Steering Committee
a. The Steering Committee shall consist of the President, the Director and additional three members.
b. The Steering Committee shall run the daily management of the IFT. The Steering Committee through the
Director shall inform the members of the IFT activities, provide them with advice on request, and assist them
when possible.

Article 9: The President
a. The President shall be eligible for re‐election as long as he or she is ready to do so.
b. The President shall convene and chair the meetings of the Assembly, the Council and the Steering Committee. In
the absence of the President the chair will be taken by the Director, and in the absence of the later by a member
of the Steering Committee.

Article 10: The Director
a. The Director shall be eligible for re‐election as long as he or she is ready to do so.
b. The Director shall take minutes of the proceedings of the various meetings, issue notices to the members, and
conduct correspondence. The Director shall submit periodic report on activities to the Council.
c. The Director shall exercise the day‐to‐day management of the IFT, as well as powers delegated by the Council
and the Steering Committee.

Article 11: Amendment of the Statutes
All of the articles of these statutes may be amended by approval of the Assembly by a resolution adopted by a two‐
thirds majority of those present.

Article 12: Dissolution
The IFT will be dissolved through:
a. A decision made by the Assembly.
b. The complete absence of members.
c. A decision made by the Head of the UNESCO Chair in Bioethics
9
Scientific Program ‐ Tuesday, January 6, 2015
08:00‐09:00: Registration
09:00‐10:30: Parallel Sessions
Bioethics: General (1) Medical Ethics Ethics: General (1) Psychiatry, Ethics & Law Medical Law (1)
Chair: D. Flescher Chair: Y. Blachar Chair: J. Lamoure Chair: S. Wolfman Chair: T. Doležal

Co‐Chair: S. Dejavsarov Co‐Chair: T. Karni Co‐Chair: V. Rakic Co‐Chair: R. Abramson Co‐Chair: T.T. Noguchi
How not to run a vaccine The ethical roadblocks Can moral Bioethical dilemmas in Personal injury
program: Ethical issues to medical tourism bioenhancement be assessing causality in compensation in Czech
and transparency Elinor Goshen, Israel moral? psychiatry Republic and the
Diana Flescher, Israel Vojin Rakic, Serbia Samuel Wolfman, Israel international classification
Freedom of expression of functioning, disability
MOMA call center for
versus respect for the Ethical treatment in and health
monitoring and Ethical considerations
profession psychiatry Tomáš Doležal,
treatment regarding evidence‐
Baruch Chen, Israel based medicine: Does Anthony Dinnen, Czech Republic
Sara Dejavsarov, Israel
Australia

Mass prisoner hunger one size fit all?
“EU”, short form for
Bioethical aspects of strike in 2014: From Joel Lamoure, Canada Some problems in medical “Ethical” Union? The role
activities of the Heydar theory to practice of ethics in European
ethics in modern
Aliyev Foundation Do quality improvement Union law
Tami Karni, Israel psychiatric practice
Anar Alakbarov, (QI) activities need Markus Frischhut, Austria
Ronald Abramson, USA
Azerbaijan The role of the physician in approval by institutional A woman's right to

To be or not to be a live "reality TV" review board (IRB) or The evolution of the abort a viable fetus

kidney donor: A parent’s Malke Borow, Israel are they an ethical objective cause concept Pnina Lifshitz‐Aviram, Israel
personal principle ‐ cause
obligation inherent to from the psychiatric and

Vaccination of health any clinical activity? Overview of the US

for patient’s death legal points of view quality assurance
professionals Mayer Brezis, Israel
Marija Emilija Kukubajska, Roberto Mester, Israel program for health care
Leah Wapner, Israel
Macedonia Thomas T. Noguchi, USA
10:30‐11:00: Coffee Break
11:00‐12:30: Opening Session
Chair: Prof. Amnon Carmi, President of the Conference
Welcome Greetings Dr. Xavier Deau, President, World Medical Association
Prof. Thomas Noguchi, President, World Association of Medical Law
Dr. Dafna Feinholz, Chief, Bioethics and Ethics of Science and Technology Section, UNESCO
Mr. Nir Barkat, Mayor of Jerusalem
Prof. Arnon Afek, Director General, Israel Ministry of Health
Judge (ret.) Prof. Eliezer Rivlin, Chairman, Board of Governors, The International Center of Health, Law and Ethics
Prof. Aharon Kellerman, President (ret.), Zefat Academic College
Dr. Leonid Eidelman, Chairman, Israel Medical Association
Opening Speeches The ethical side of Health Technology Assessment (HTA)
Dr. Xavier Deau, President, World Medical Association
Ethical dilemmas and moral duties of a hospital director
Prof. Jonathan Halevy, Director General, Shaare Zedek Medical Center
12:30‐13:30: Lunch Break
Bioethics: General (2) Military Medical Ethics: General (2) Research (1) Medical Law (2)
Ethics
Chair: T. Chelouche Chair: Z. Lederman Chair: P. Thangaraju Chair: M. Tal Chair: F. Aliyeva
Co‐Chair: R. Halpin Co‐Chair: S.M. Eagan Co‐Chair: M. Hamiti Co‐Chair: Co‐Chair: V. Mammadov
Chamberlin M. Botbol Baum
Bioethics and the Force‐feeding hunger Conflict of interest between Ethical issues in Malpractice, personal
Holocaust: Teaching strikers: Humane or the institutional goals for medical fields damage & medical
lessons from the past inhumane treatment? advancement of knowledge Rupa Rajbhandari liability
for future healthcare Mirko D. Garasic, Israel and institutional ethics ‐ Singh, Nepal S. Davide Ferrara, Italy

issues and solutions
professionals Moral responsiblity Italian regulation of
P. Thangaraju, India
Tessa Chelouche, Israel during atrocities: The The use of fMRI for advance directives:

Yuana Ken Case Study Compulsory vaccination and research outside the Legal comparison with
The Jewish ethical Zohar Lederman, the collective good: Going other Western
hospital setting
response to Singapore beyond a civic duty? European countries
Michael Tal, Israel
bioethical dilemmas
Nicola Glover‐Thomas, UK Denard Veshi, Albania
Instrumentalization
in the Holocaust Midwives’ experiences on the

of medicine: The Capabilities as a The rights of disabled
Alan B. Jotkowitz, Israel physician‐soldier & use of partogram in the
challenge to justice as people in Azerbaijan
management of women during
Primum non nocere v. civilian medical care equality, Helsinki's Republic
Sheena M. Eagan labour at Limpopo, S. Africa
caveat emptor revisions and the Fatima Aliyeva,
Chamberlin, Germany Thanyani G. Lumadi, South Africa violence of Azerbaijan
Ross Halpin, Australia
Political hunger Ethical dilemma in the use of benevolence

information technology Protection of public
The Biological Will™‐ strikes and force‐ Mylene Botbol Baum,
Mentor Hamiti, Macedonia health is in the focus of
A paradigm in fertility feeding: An Belgium the state
Irit Rosenblum, Israel alternative view Leading the change in medical Vugar Mammadov,
Yechiel Barilan, Israel practice Azerbaijan
Petar Chavdarovski, Bulgaria
10
Scientific Program ‐ Tuesday, January 6, 2015
Bioethics: General (3) Military Law and Ethics Ethics: General (3) Research (2) Medical Law (3)

Chair: D. Mishori Chair: L. Zhen Chair: I. Zilberstein Chair: C.P.H. Myburgh Chair: M. Levy
Co‐Chair: M. Mullen Co‐Chair: W. Chen Co‐Chair: O. Lev Co‐Chair: V. Rahimzadeh Co‐Chair: J. G. Makama
The controversy over The study and analysis Does directing patients Disclosing incidental Patients’ perception and
medical cannabis in of confidentiality in the to additional private findings in pediatrics: actual practice of
Israel: Science, ethics forensic identification physical therapy care Health professional privacy & confidentiality
and democracy Canping Wang, China provoke ethical perceptions and insight in surgical outpatient
Daniel Mishori & Zach dilemmas? Vasiliki Rahimzadeh, departments of general
Klein, Israel The principles of Ilana Zilberstein, Israel Canada hospitals, Kaduna,

fairness and justice in

Nigeria
Under the regulation forensic investigation How ethical are
radar: Strategies and Israeli code of ethics for Jerry G. Makama,
and identification researchers during the
tactics of pharmaceutical practitioners of Nigeria
work analysis practical implementation
companies to promote occupational health
Wenwubei Chen, China of research procedures?
drugs and medical Raz Dekel, Israel The impact of animal
C.P.H. Myburgh, South
products in Israel The study of the violence in the human
Africa
Yaffa Shir‐Raz, Israel national customs in Assisted reproductive violence

technologies and The rationale of the Gina Lorena García M.,
Negotiating away health? forensic identification
parenting rights in a European Union human Colombia
Legal and ethical Keran Li, China
Jewish democratic state: embryonic stem cell
implications of the Trans The application of public The case of the Ova research funding The guilty innocence of
Pacific Partnership (TPP) security, procuratorial Donation Law Jana Zuscinova, Slovakia consumers
and the Trans Atlantic policemen health survey Ori Lev, Israel

Pasqualino Santori, Italy
Trade & Investment Governance and ethical
in ethnic minority areas regulation of human
Partnership (TTIP) in Yunnan Province Doctor competencies in The organ shortage and
Elizabeth Wiley, USA research in sub‐Saharan

Xuecheng Liu, China medical ethic & effective Africa: A systemic review its consequences: Legal
Ethical and socio‐historical communication skill of published studies from and ethical reflections
challenges in providing among the alumni of 1980 to 2014 on state incentives as
health services to Inuit faculty of medicine Muhammed Suraj Yusuf, possible remedies
children and youth: Universitas Airlangga Nigeria Melanie Levy, Israel
Lessons for implementing Agung Pranoto,
health services in Indonesia Individual patient rights

developing regions & new bio‐technologies
Michelle Mullen, Canada in medicine
Sanja Jovanovska,
Macedonia
Bioethics: General (4) Ethical and Legal Issues in Ethics: General (4) Research (3) Medical Law (4)
Medical Rehabilitation
Chair: E. Thorne Chair: A. Ohry Chair: R. Gilbar Chair: D. Fu‐Chang Tsai Chair: Z. Todorović
Co‐Chair: A. Jain Co‐Chair: I. Treger Co‐Chair: M. I. Siebzehner Co‐Chair: J. Kuře
Ebola virus and Ethical issues in Law, bioethics and Procedural ethics: Drugs funding and
infectious disease: The rehabilitation medicine medical decision‐ Tensions between social rationalization, in
duty of physician to cure Avi Ohry, Israel making: The impact of sciences and biomedical healthcare systems
and the possible risks – culture sciences Carla Barbosa, Portugal
the halachic dilemma Malpractice in Roy Gilbar, Israel Séverine Colinet, France

Cesare Efrati, Italy rehabilitation medicine Developing joint ethics Neuroethics in drug
The morality of
Iuly Treger, Israel review mechanism for development
deportation of sick
Gender discourses and multi‐center clinical Zoran Todorović, Serbia
illegal immigrants
bioethics What should be the trial in Taiwan:
Miriam I. Siebzehner, Experience & reflection
Angela Aparisi, Spain desired medical Ethical considerations in
Israel for two year result
expertise when legal representation of
Evasion of one’s own evaluating plaintiff's Doctors as bystanders Daniel Tsai, Taiwan people under

rules: Implications for functional disability and during the Indigenous The ethical challenges of guardianships in medical

ethical harmonization needs? Australian genocide conducting a population‐ procedures
Emanuel Thorne, USA Avi Rubinstein, Israel Peter Honeyman, based screening for non‐ Meytal Segal‐Reich,
Australia communicable diseases Israel
in a setting with limited
Capacity assessment in universal health coverage
health care Fatima L. Ciroma, Nigeria

professionals – A major Research ethics
challenge in an aging committees: From theory
society to practice and back again
Yoram Maaravi, Israel Josef Kuře, Czech Republic
19:30: Welcome cocktail and get‐together dinner
11
Scientific Program ‐ Wednesday, January 7, 2015
HALL A HALL B HALL C HALL D 08:30‐10:30 HALL E
Bioethics: General (5) Bioethics: Education (1) Ethics: General (5) Ethics and Regulation of Psychology, Ethics and
Inter‐Country Medically Law
Assisted Reproduction (1)
Chair: M. Lupton Chair: D. Balakrishnan Chair: E. Richter Chair: C. Shalev Chair: A. Quitz
Co‐Chair: S. Davtyan Co‐Chair: A. Prokopiou Co‐Chair: E. Katzenelson
Eliminating prenatal sex A vertically integrating Medical ethics and Can we see the baby Interdisciplinarity: The
selection? The global model for teaching genocide: Troubling bump please? SAMA role of the psychologist in
agenda and national bioethics to under‐ unmet challenges Resource Group for the doctor‐patient
action plans graduate medical Elihu Richter, Israel Women and Health, relationship: Information
Johanna Kostenzer, Austria students New Delhi, India and demand

D. Balakrishnan, India Ethics of chronic pain FILM & discussion Patricia Oliveira, Argentina
“Dr.” Watson: AI, ethics,
control; a grey area of
and the future of Problems and Cultural blindness:
doctors’ power Capabilities approach
medicine perspectives in bioethics Potential pitfalls for
Andreas Prokopiou, Cyprus for mutual fellowship in
Amy DeBaets, USA education in the CIS psychologists,
commercial surrogacy
countries psychiatrists &
The ethical and legal Ubuntu: Alterity as a Sheela Saravanan,
Susanna Davtyan, Armenia pediatricians when
consequences of perspective for peace Germany
diagnosing Ethiopian
converging Problem formation of Flora Strozenberg, Brazil
children
biotechnologies the ethical regulators of Commodification of the
Edna Katzenelson, Israel
Michael Lupton, Australia the physician Implications of female body: An
professional activities ubiquitous use of smart anthropological view Psychological aspects of

Alena Donika, Russia spectacles or digital Adi Moreno, UK moral decision: Violations

eyeglasses of professional discretion
Knowledge and
Sody Naimer, Israel in Former East Germany
attitudes of medical
(DDR)
students concerning
Andrea Quitz, Germany
opiophobia – a cross
sectional study Ethical implications of
Milica Prostran, Serbia modification of
traumatic memories
Marcia Sokolowski, Canada
Bioethics: General (6) Bioethics: Education (2) Ethics: General (6) Ethics and Regulation of Issues in Psychology,
Inter‐Country Medically Law and Ethics in Israel
Assisted Reproduction (2)
Chair: E. Toader Chair: S. Popova Chair: S. Kottek Chair: T. Eldar‐Geva Chair: M. Zaki
Co‐Chair: D. Sotirova Co‐Chair: N. Sedova Co‐Chair: C. Greenberger
Moral exclusion: Bioethics in the training Jewish medical ethics: Concepts of identity and Issues in psychology,
Implications for and management of On physicians' prayers – related ethical issues in law and ethics in Israel
bioethics sport devotion to the Lord, third‐party assisted Moshe Zaki, Israel

Daniela Sotirova, Iva Miteva, Bulgaria devotion to the patient reproduction
Principles of psychological
Bulgaria Samuel Kottek, Israel Gabriele
Teachers of bioethics in assessment of parental
Werner‐Felmayer, Austria
search of new The ethics of clinical competence in the Muslim
Migration of doctors
perspectives judgment and medical ‐ Arab society in Israel
and multiculturality in The rights of the child: A
Sashka Popova, Bulgaria intuition in the writings Emad Gith, Israel
the global context welfare principle
of Moses Maimonides
Elena Toader, Romania Ethnic bioethics in applied to children born Bio‐ethical issues
Kenneth Collins, Israel
education in transnational concerning clinical neuro‐
Human right, human Natalia Sedova, Russia Enteral nutrition in end surrogacy arrangements psychology in general, and

responsibility and social of life: The Jewish Marsha J. Tyson Darling, mainly in damages claims
Less talk – more action:
responsibility in the halachic ethic USA in cases of brain injury
Teaching ethics to
communicable disease Chaya Greenberger, Chanan David, Israel
Generation Y
control Israel Concerns about women
Zahava Davidow, Israel In the worst interests of
Siti Pariani, Indonesia When religion and in international child the child: Using non‐
Teaching bioethics and medicine intersect: The protection conventions validated psychological
human rights through example of taharat Rhona Schuz, Israel tools in child custody
cinema and popular TV hamishpacha disputes
series: A methodological Deena R. Zimmerman, From Baby M to Baby Israel Oron, Israel
approach Israel M(anji): Regulating
international surrogacy Dilemmas concerning
Juan Jorge Michel
agreements custody for high conflict
Fariña, Argentina
Yehezkel Margalit, Israel divorce with a focus on
early childhood
Iris Berent, Israel
12
Bioethics: General (7) Bioethics: Education (3) Ethics: General (7) Ethics and Regulation of Emotional Intelligence
Inter‐Country Medically and Ethics for Effective
Assisted Reproduction (3) Treatment
Chair: W. Canping Chair: V. Nanben Omole Chair: A. Oyefabi Chair: S. Kahn Chair: D. Keidar
Co‐Chair: Li Zhen Co‐Chair: J. Hellmann Co‐Chair: L. Zur‐dovrat
The application of Ethical issues arising The autonomy question Surrogacy, the debate in Patient's rights law and
bioethics principle on from a comparative of the prostitution: An Israel and France in culturally competent
forensic medicine study of performances integrative model cultural and historical nursing care: An Israeli
Li Zhen, China in two entrance Renana Leviani, Israel perspectives perspective
examinations for

Etienne Lepicard, Israel Rabia Khalaila, Israel
Child marriage in
The study and analysis medical undergraduate The adoption of
Nigeria: A violation of
on the principle of admission into a Moving towards an Buddhism’s Principles as
human rights
respect in the forensic Nigerian University international convention means of improving
Awawu Grace Nmadu,
investigation and Victoria Nanben Omole, on surrogacy and physicians’ work with
Nigeria
identification Nigeria artificial reproduction: Is terminally ill patients
Shuboqing Huang, China Willingness to treat it time? Ruth Wolf, Israel
Using innovative infectious diseases: Debra Wilson,
A paternity case with methods to inculcate Comparing two New Zealand The role of the Israeli

multistep microsatellite ethical thinking and distinctive medical courts in formulating
mutations in locus behaviour among health schools Mothering for money: the physician‐patient
D5S818 science students Avram R. Shack, Israel Regulating international relationship
Hong Liang, China Animesh Jain, India

intimacy Limor Malul, Israel
Ethical issues in Pamela Laufer‐Ukeles, USA

knowledge, perceptions Ethical dilemmas in
The study and analysis Bioethics education of a
and exposure to physician‐patient
on the principle of diverse student group: Epigenetics and the
hospital hazards by relationship in
informed consent in the Development of a Assisted Reproductive
patient relatives in a multi‐cultural society
forensic identification curriculum Technologies
tertiary institution in Rotem Waitzman, Israel
Lv Duan, China Jonathan Hellmann, Irina Pollard, Australia
North Western Nigeria
Emotional intelligence,
Canada Adegboyega Oyefabi,
ethics and ties between
Nigeria them
Learning medical law
and bioethics through Ethics & professionalism: Daniella Keidar, Israel

an interprofessional One and the same ethics
experience – The Zefat workshop for
legal clinics project physiotherapists and
Oren Asman, Israel occupational therapists
Lihi Zur‐dovrat, Israel
Bioethics: General (8) Bioethics: Education (4) Hunger Strike of Ethics and Regulation of Technology Dependent
Prisoners Inter‐Country Medically Children: The Implication
Assisted Reproduction (4) on Longevity and
Quality of Life
Chair: V. Trigueiro Chair: M. Benyakar Chair: S. Glick Chair: Chair: Z. Hillel‐Diamant
Santos Adinolfi Co‐Chair: M. Vasinova Co‐Chair: R. Aroni G. Werner‐Felmayer
Co‐Chair: A. Alichniewicz
Bioethical controversies – Workshop for clinical Force feeding hunger A parent or a gamete An overview of the
Personal dignity, homo ethics case conference – strikers in the Jewish donor? Legal needs of technology‐
economicus and how should it be held? law consequences of an dependent children in
commercialization of body Mitsuyasu Kurosu, Japan Yisrael Katz, Israel unsettled debate 2015
Anastasia Zakariadze,
Judit Sándor, Hungary Eliezer Be'eri, Israel
Clinical courses in open Force‐feeding hunger‐

Georgia

distance learning. Is it striking prisoners‐ Fertility policy in Israel: Ethical considerations in
Human enhancement ethically sound? Critical another view From exemplary local pediatric physical
care nursing perspective Shimon Glick, Israel practice to a global therapy
and narrative self
Maria Moleki,

model Julie Smerling‐Kerem,
Anna Alichniewicz, Poland The right not to die: Etti Samama, Israel
South Africa Israel
Who decides what

Human enhancement Research data about constitutes autonomy, Ethics and regulation of Beyond my body’s
and morality: Some inter‐country medically
teaching bioethics quality of life and futile limits: Imagination in
doubts assisted reproduction
through cinema and TV treatment in a culture of (ERIMAR) – A call for service of children with
Nenad Cekić, Serbia series: House MD ageism severe multiple
action
Moty Benyakar, Argentina Rosalie Aroni, Australia Carmel Shalev, Israel disabilities
Bioethics approach in
Shifra Wohlgelernter,
engineering formation Youth bioethics project
Israel
Valeria Trigueiro Santos Miroslava Vasinova, Italy

Adinolfi, Brazil
13
Bioethics: General (9) Bioethics: Education (5) End of Life (1) Assisted Reproduction (1) Medical Law (5)
Chair: B.P. White Chair: O. Karnieli‐Miller Chair: C. Ding Chair: T. Le Xuan Chair: D. Greenbaum
Co‐Chair: I.A. Joshua Co‐Chair: B. Broeckaert Co‐Chair: T. Katz Peled Co‐Chair: N. Eyal
Treating dementia and When law, ethics, Withdrawal of life‐ Reproductive ethics, Decreased mental
multiculturalism: professionalism and sustaining treatment: A rights and evolving capacity jeopardizes
Exploring the perceptions psychology come alive: comparative analysis of Israeli legislation decision making process
of multicultural Teaching medical mainland China, Taiwan Yardena Cope‐Yossef, of patients in critical
professional caretakers in students an integrated
and Hong Kong Israel condition
Israel regarding autonomy course based on real‐life
Ding Chunyan, Ehud Shalmon, Israel
and human dignity medical case Pick‐Up babies ‐ surrogacy
Miriam Bentwich, Israel Orit Karnieli‐Miller & Gad Hong Kong
in the developing world:

Cohen‐Rappaport, Israel Ethical, legal and social
Environmental refugees ‐ New technologies, old
Ripple effect of implications of new and
Electrohypersensitives Case study and problem exploitation
simulation training for emerging technologies:
(EHS) in the digital world – base methodology in Tamar Katz Peled, Israel
a disabled population, end‐of‐life care Exoskeletons
bioethics education Meir Frankel, Israel Reforming the law on Dov Greenbaum, Israel
deprived of home, work
and basic rights Irine Zarnadze, Georgia surrogacy in Vietnam

Yael Stein, Israel Promoting bioethics in Belgian Muslims and Tung Le Xuan, UK Development of patient

the high school level by end of life ethics
rights and health care
The expanded and Reproductive rights,
evolving role of the ethics integrating the case‐ Bert Broeckaert, Belgium legislation policy in
poverty & development Georgia
committee in a Planetree based approach to
Ethical dilemmas in the Martha Miranda, Shalva Zarnadze,
patient and family‐ ethical decision‐making
electronic medical era: Colombia Georgia
centered environment model
Bernard Paul White, USA Richard Deanne Sagun, An inter‐religious

Children in armed Philippines comparison Defending “Big Brother

conflicts and child
Yitschak Copperman, MD”: The ethics of
Breaking bad news, Israel electronic adherence
soldiers in Africa: Human
rights and ethical issues ethics & communication monitoring in Uganda
Istifanus Anekoson in the movies Nir Eyal, USA
Joshua, Nigeria Ruth Kannai, Israel
19:30: Gala farewell dinner and folkore evening
Scientific Program ‐ Thursday, January 8, 2015
Medical Law (6) End of Life (2) Bioethics: General (10) Assisted Reproduction (2) (1) ‫מושב בעברית‬
Chair: M. Ottonello Chair: D. Sperling Chair: D. Chemtob Chair: N. Salomé Lima ‫ נילי טבק‬:‫יו"ר‬

Co‐Chair: F. Adiri Co‐Chair: I. Milinkovic Co‐Chair: R. Veselska Co‐Chair: R.Haimov‐Kochman
Knowledge, attitude and Views on end of life When only the wealthy Bioethics and its ‫רכיבים אפיסטמיים בביסוס‬
practice of informed situations as expressed recover: The medical promethean challenge ‫מוסרית‬-‫גישה טיפולית‬
consent by medical Natacha Salomé Lima, ‫בסיטואציות‬
by first‐degree relatives ethics of addiction ‫קונפליקטואליות‬
doctors in a teaching of patients in a treatment and Argentina
hospital in Zaria,
‫אלה קורן‬
vegetative state recovery Pre‐implantation genetic
Northwest Nigeria diagnosis for sex selection for
Ittai Dayan, Israel Constance Scharff, USA ‫האחות בפסיכיאטריה‬
Farouk Adiri, Nigeria
non‐medical reasons: Position ‫ סוהר או סוכן‬,‫משפטית‬

In defense of suicide
Disease awareness and statement of the ethics ‫טיפול סיעודי? כפל‬
tourism (ST) National Ethics
quality of health committee of the Israel ‫הנאמנות של אחות‬
Daniel Sperling, Israel Committee on ‫בפסיכיאטריה‬
information on clinical Fertility Society

HIV/AIDS – the Israeli Ronit Haimov‐Kochman, ‫נוי‬-‫דור בר‬
procedures: On ethical places: The
Observational study in experience Israel
practice of ‘terminal Daniel Chemtob, Israel :‫להתריע או לא להתריע‬
patients with cancer and discharge’ in clinical To what extent does a ‫הגישה ההלכתית יהודית‬
ALS
settings and the good surrogate have real ‫חיה גרינברגר‬
Marcella Ottonello, Italy Who owns our dead autonomy?
death in Taiwan bodies?
Patients’ perceived to Julia Feuer, Israel ‫טעויות בטיפול והסיעוד‬
Yicheng Chung, Japan Renata Veselska,
‫חיה רז‬
their rights to information
Communicating with
and its implementation in Legal treatment of the Czech Republic
sufferers: Lessons from the ‫עמדות של אחיות מוסמכות‬
healthcare right to a dignified Book of Job ‫אקדמיות כלפי אתיקה‬
Ivan Rahmatullah, death in Bosnia & An Italian court ruling: Joseph Tham, Italy ‫בפרסום מדעי‬
Indonesia Herzegovina: Legal and “Autism is caused by
‫נילי טבק‬
Cross‐border reproductive

ethical issues MPR vaccine” care: The case of
Can prevention of eating
disorders be regulated? Igor Milinkovic, Alessandra Pentone, pre‐implantation genetic
Israel's "Modeling Act" as Bosnia and Herzegovina Italy diagnosis (PGD)
a case study Shachar Zuckerman, Israel
Galya Hildesheimer &
Hemda Gur‐Arie, Israel
14
Scientific Program ‐ Thursday, January 8, 2015
HALL A HALL B HALL C 11:00-13:30 HALL D 10:30‐12:30 HALL E HALL F
Medical Law (7) End of Life (3) ‫מושב דיאטניות‬ ‫ועדות אתיקה במערכת‬ (2) ‫מושב בעברית‬ ,‫ מוח‬- ‫תקשורת אנושית‬
:‫הבריאות בישראל‬ ‫רגש והתנהגות‬
– ‫אתגרים והצלחות‬ ‫)אינטליגנציה רגשית‬
‫ניסיון מהשטח‬ (‫והיבטים אתיים‬
Chair: P. Apinis Chair: ‫ אירית פורז‬:‫יו"ר‬ ‫ נעמה ויצ'נר‬:‫יו"ר‬ ‫ עדי ליברטי‬:‫יו"ר‬ ‫ דניאלה קידר‬:‫יו"ר‬
Co‐Chair: P. Louis Palatty
S. Zuckerman Co‐Chair: M. Gordon
Some of medical Determinants of ‫ קוד אתי‬:‫פתיחה‬ ‫ועדת האתיקה במרכז‬ ‫משתנים המשפיעים על‬ ‫פתיחה וברכות‬
ethical aspects of ‘end of life’ ?‫ למה‬,‫לדיאטניות‬ ‫הרפואי לגליל המערבי‬ ‫התמודדות אנשי הצוות‬ ‫דניאלה קידר‬
Eastern Europe ‫אירית פורז‬ ‫אירית ויסמן‬ ‫הרפואי עם פטירת‬
decision making: ‫תינוק במחלקה לטיפול‬ ‫תדמית הגוף ומקומה‬
after the collapse of A qualitative
the USSR ‫דילמות אתיות בטיפול‬ ‫הוועדה המוסדית לפי‬ ‫נמרץ בילוד‬ ‫במבנה האישיות‬
approach ‫התזונתי בקרב‬ ‫חוק החולה הנוטה‬ ‫סופיה דומבה‬ ‫חנן דוד‬
Peteris Apinis,
(patient/caregiver ‫מאושפזים‬ ‫למות במרכז הרפואי‬
Latvia ‫ ענבל‬,‫הילה זהרוני‬ ‫רבין‬ ‫פרטיות המידע הרפואי‬ ‫ התנהגות‬,‫ רגש‬,‫מוח‬
perspective)
Ethical ‫ עפרה גולן‬,‫צוריאלי‬ ‫שלומית פרי‬ ‫בעידן רשתות חברתיות‬ ‫ופסיכיאטריה‬
Princy Louis Palatty,
considerations of ‫שולמית אוחנה‬ ‫חיים קנובלר‬
India ‫השוואת הקוד האתי של‬ ‫ועדת האתיקה של‬
using off label ‫דיאטניות בישראל לקוד‬ ‫מכבי‬ ‫עמדות ותפיסות כלפי‬ ‫המרכז הבינלאומי‬
medical treatments Rites and rituals of ‫האתי של דיאטניות‬ ‫עפרה גולן‬ ‫אנשים עם עודף‬ ‫ משפט‬,‫לבריאות‬
and medications in ‫ תהליך בניה‬,‫בעולם‬ ‫השמנת יתר‬/‫משקל‬ ‫ואתיקה‬
dying: A shift to
disasters ‫והטמעה‬ ‫ועדת האתיקה הארצית‬ ‫בקרב פיזיותרפיסטים‬ ‫אמנון כרמי‬
Shlomit Zuckerman, medical technology
‫יוספה כחל‬ ‫ ואיידס‬HIV‫ל‬ ‫מוסמכים‬
Israel Michael Gordon, ‫מיכל אלבוים גביזון‬ ‫דיון כללי‬
Canada ‫דניאל שם טוב‬
‫דיון וסיכום‬
Personal integrity, ‫דילמות אתיות‬
informed consent Ethical issues in the ‫בבריאות וההקשר הרב‬
and human ‫תרבותי‬
prolongation of life
tissues/organ ‫שרה ניסים‬
in the terminally ill
transplantation
Anu Kant Mital, ‫ידע ועמדות של אחיות‬
after Petrova versus
India ‫בתי חולים כלליים ביחס‬
Lithuania:
‫לטיפול באסירים‬
Considerations ‫כבולים‬
from the Spanish Last rights: End of
‫דורית רובינשטיין‬
legal system life decisions in
María Magnolia Canada
Pardo‐López, Spain Mark Handelman,

Ethical dilemmas in Canada
the "Protective
Edge" Operation
Uria Moran, Israel
HALL A HALL B HALL C HALL D 13:00-15:00 HALL E
Ethics of Mental First Aid Gnawing Ethical Ethics Dilemmas in Pain ‫ מקומם של בני‬: ‫סדנה‬ (3) ‫מושב בעברית‬
& First Aid Organizations Conundra ‫המשפחה בתהליך הדיון‬
‫האתי‬
Chair: E. Jaffe Chair: T. Bard Chair: M. Tal ‫ גילה יעקב‬:‫מנחה‬ ‫ נילי טבק‬:‫יו"ר‬
Co‐Chair: E. Sharon
Ethical dilemmas in the You know it is torture How tightly are pain ‫ מקומם של בני‬: ‫סדנה‬ ‫תשאול צוות רפואי לגבי‬
prevention of PTSD when there is official medicine and moral ‫המשפחה בתהליך הדיון‬ ‫ היבטים‬:‫אלימות במשפחה‬
among volunteers terror standards related to ‫האתי‬ ‫אתיים וחוקיים‬
responding to trauma Barry Roth, USA each other? ‫מירב בן נתן‬
Haim Y. Knobler, Israel

Elon Eisenberg, Israel

Decision making in ‫קדושת החיים ובדיקות סקר‬
Suicide prevention in settings of uncertainty Ethical dilemmas in the ‫עפ"י פסקי הלכה של גדולי‬
emotional first aid Terry Bard, USA management of pain ‫הרבנים בישראל בדור‬
services: Ethical

Alan Rubinow, Israel ‫האחרון‬
Moral injury
‫מנחם חיים ברייר‬
dilemmas Mark F. Poster, USA Towards a rational
Itzhak Gilat, Israel
approach to the ethics ‫הטמעת הקוד האתי בקרב‬
Institutional approach
of pain ‫סטודנטים לסיעוד‬
A revised ethical code of autistic children.
Z. Harry Rappaport, Israel ‫עדי ליברטי‬
for an association of A contribution from
mental first aid bioethics and Pain, consciousness and

Shiri Daniels, Israel psychoanalysis the cerebral cortex
Carlos Tewel, Argentina Marshall Devor, Israel
* Subject to last minute amendments
15

Poster Presentations

New models of public health research: Developing an ethical framework for research using surveillance data in
resource limited countries
Evelyn Anane‐Sarpong, Switzerland
Psychological e‐volunteering among Russian speakers
Olga Bermant‐Polyakova, Israel
Heterologous in vitro fertilisation now admitted in Italy: Constitutional court’s judgment n. 162/2014 abolished
the ban of involve gametocytes outside the couple
Pietro Ferrara, Italy
Ethical decision making and patient autonomy views among the nursing staff
Shani Fisher, Israel
The bioethics of compulsory treatment determined by a court order
Gabriel José Gauer, Brazil
Dermatological ethical problems of personalized medicine
Irina Krainova, Russia
The Italian information system for monitoring errors in healthcare
Luigi Tonino Marsella, Italy
Lawsuits related to the health in Brazil – a truly “factory” of indemnification for moral damages
Paulo de Argollo Mendes, Brazil
Behavioural subjects in the public health studies: Historic parallels and modern alternatives
Vanina Michaylova, Bulgaria
The waiting game: Is it time to change the rules?
An ethical proposal to legalise a regulated system of kidney sales
Erica Morris, UK
Ethical issues in paediatric physiotherapy practice: A survey of physiotherapists in Ghana
Bertha Oppong‐Yeboah, Ghana
E‐Health: The necessary balance between effectiveness of the health system and protection of fundamental rights
María Magnolia Pardo‐López, Spain
Adolf Sannwald – enemy casualty
How a notation can turn the worth of a German pastor into the wickedness of a Nazi evil
Alessandra Pentone, Italy
Mitochondrial replacement therapy and parenthood
Daniel Sperling, Israel
16

Abstracts
Oral Presentations
Abstracts of Oral Presentations 19
PROTECTION OF PUBLIC HEALTH IS IN THE FOCUS OF THE world. This way of thinking lends itself to mass production
STATE maintenance treatments which do not have much promise in
helping patients who have these illnesses toward recovery.
Adila Abbasova1, Mahammad Bazigov1, Vugar Mammadov2, Yet there is a basis in science which supports the reality of
Ilgar Mammadov3 subjective mental experiences. There are experiments in
1
Department of Social Policy Legislation of the Parliament of quantum physics that suggest that the consciousness of the
Azerbaijan Republic experimenter can affect the outcome of the experiment. Some
2
Heydar Aliyev Center, Azerbaijan Bioethics and Medical Law physicists have come to believe that consciousness is a
Association, Azerbaijan Unit of International Network of UNESCO fundamental property of the universe. Others have suggested
Chair in Bioethics that the universe is organized in levels of organization and
3
Ministry of Justice, Azerbaijan Republic causality and that consciousness occupies a different level from
vumammadov@yahoo.com the underlying neurological level that supports it.

In this presentation, these ideas will be spelled out and clinical
In recent years improvement of normative legal base on health
examples will be given that document the ethical inadequacies of
and its raise to international level was constantly in the center of
the currently dominant biological reductionistic approach in
attention. For this purpose a number of laws were developed and
psychiatry.
adopted by the Parliament. Adoption of main Law on “Protection
of health of population” of Azerbaijan Republic in 1997, which
regulates created relations between state bodies, as well as

KNOWLEDGE, ATTITUDE AND PRACTICE OF
governmental and non‐governmental subjects of health system,
and citizens in the field of protection of health became a very INFORMED CONSENT BY MEDICAL DOCTORS IN A
important event in the history of Azerbaijan healthcare. TEACHING HOSPITAL IN ZARIA, NORTHWEST NIGERIA

One of the priority directions of protection of health of
Farouk Adiri1, Bilkisu Gulma2, Istifanus Joshua1, Grace Nmadu1
population is implementation of preventive measures. Laws “On 1
Kaduna State University, Nigeria
Sanitary‐epidemiological well‐being”, “On Fight against 2
Ahmadu Bello University, Nigeria
tuberculosis in Azerbaijan Republic”, “On Prevention of AIDS”,
adirifarouk@yahoo.com
“On Salt iodization”, “On Nutrition of infants and minors”, “On
State care for persons suffering from inherited blood diseases ‐ The study was aimed at assessing the knowledge, Attitude and
hemophilia and thalassemia” and others serve namely in the Practice of informed consent among medical doctors in Ahmadu
preventive measures. Bello University Teaching Hospital, Zaria in Northwestern Nigeria.
At the same time legislative acts are adopted for the purpose of A descriptive cross‐sectional study design was used to select 185
treatment of various diseases and medical‐social assistance to medical doctors in March 2011 in a tertiary center of excellence
the patients under certain diseases (tuberculosis, diabetes, iodine and referral in Northwestern Nigeria. A multi‐stage sampling
deficiency, HIV virus, hereditary blood diseases, multiple sclerosis technique was used to select the respondent. Data was collected
etc.). using self administered pre‐coded, pre‐tested questionnaire. The
In order to ensure more efficient spending of funds allocated to data was cleaned and analyzed using Statistical Package for Social
health sector from state budget the preference is given to Sciences version 17. The results were presented in tables and
adoption of state programs like “On chronic kidney insufficiency”, charts. The study showed 49.7% of the respondents were within
“On hereditary blood diseases thalassemia and hemophilia”, “On the age group 30‐39 years, mean age of 33 years, 75.7% were
Diabetes”, “On provision of cancer patients with basic males, in pediatrics department (31.4%) and house officers
antineoplastic drugs”, “On immunoprophlaxis of infectious (33.5%) with 5 years of experience or less (44.9%). About 47% of
diseases”, “On protection of health of mother and children”, “On respondents had good knowledge of informed consent. There
development of blood, blood components donation and blood was a statistically significant association between the
services”. respondents knowledge and the years of experience at p<0.05.
Ninety‐seven (97.0%) percent of the respondents had good
attitude towards informed consent but only 74% admitted to
SOME PROBLEMS IN MEDICAL ETHICS IN MODERN have given informed consent forms or secured informed consent
PSYCHIATRIC PRACTICE during the previous one year of practice. The age and mental
status of patients or their proxy was identified as criteria for
Ronald Abramson competency to give informed consent (27.6%). There was a poor
Tufts University School of Medicine, USA knowledge of informed consent among medical doctors.
Rona976@aol.com Therefore, there is need for healthcare administrators to increase

awareness and sensitization of doctors while improving practice
In recent years the field of psychiatry has drifted toward an
through training.
orientation in its teaching and treatment approaches that might
best be termed “biological reductionism. This is the notion that
all mental disorders or even mental experiences can be reduced

to neuronal, genomic, or other biological activity. Mental BIOETHICAL ASPECTS OF ACTIVITIES OF THE
disorders are considered to be brain diseases. The dominant HEYDAR ALIYEV FOUNDATION

supported psychotherapies are grounded in concrete cognitions
Anar Alakbarov
and prescribed concrete exercises. This concrete rationalistic
Heydar Aliyev Center, Azerbaijan
orientation lends itself to treatment approaches that emphasize
aal@heydar‐aliyef‐foundation.org
mostly the prescription of medications done in the context of
infrequent visits to psychiatrists and short term cognitive and The Heydar Aliyev Foundation’s numerous activities of recent
behavioral psychotherapies oriented toward concrete goals. years reflect the issues of tolerance, non‐discrimination, human
There is no room in this approach for appreciation of the life rights, human dignity, equality, cultural diversity, pluralism, social
story of a patient as well as developing an understanding of how responsibility, care of future generations, ecology, sustainable
the patient experiences his/her own conceptual and perceptual development, and other issues, which in the assemblage
20 UNESCO Chair in Bioethics 10th World Conference
constitute universal bioethical values. Their implementation authors of their own history”. Secondly, we present the narrative

promotes social‐economic development of the country. concept of personal identity developed by Charles Taylor and
Numerous projects realized by the Heydar Aliyev Foundation, Alasdair MacIntyre. According to Taylor, we achieve the
which was founded in 2004, cover, first of all, fields of science understanding of selfhood only and “inescapably in narrative”,
and education, public health, social sphere, culture and the structure of narration is a meaningful wholeness assigning
environment. These projects now are strongly supported by significances and values to the events of our lives. The individual
Heydar Aliyev Center, state organization created by Decree of the narration unfolds itself in the social narration and draws
President of Azerbaijan Republic for support of such kind of social meanings and values from the social frameworks. Social
and humanitarian projects aimed for development of country for narration changes over time and the changing framework
future generations. All this issues represent high significance involves also the development of medicine and biotechnology.
from bioethical point of view. In our conclusions we argue that like some medical novelties
The Heydar Aliyev Foundation paying much attention to the have been incorporated into this ongoing process to become a
general development of science and other fields is actively common medical practice with time, also human enhancement
contributing to creation of favorable conditions for international could be embraced by social narration and become an element of
dialogue, cooperation with international organizations. Thus, on the framework within which the individual self tells his/her
initiative of Mrs. Mehriban Aliyeva, the President of the Heydar meaningful life‐story.
Aliyev Foundation, UNESCO and ISESCO Goodwill Ambassador,
the First Lady of Azerbaijan Republic and with direct support of
the Heydar Aliyev Foundation the 18th Session of the UNESCO THE RIGHTS OF DISABLED PEOPLE IN
International Bioethics Committee was held in Baku in May, 2011 AZERBAIJAN REPUBLIC
and highly appreciated by UNESCO officials. Holding of this
Conference promoted development of bioethics in Azerbaijan, F. Aliyeva, A. Aliyeva

raising public interest and creating grounds for scientific Baku State University, Azerbaijan
researches in the country. lawyer_afatima@rambler.ru

Implementation of the universal bioethical principles declared by The democracy set up and expanded to the deepest stages of
the UNESCO Universal Declaration on Bioethics and Human society by our National Leader Heydar Aliyev allows the
Rights can be traced as the leitmotif of the Heydar Aliyev protection of human rights in Azerbaijan. Firstly, the laid
Foundation’s activities. Thus, activities in the field of public limitations were removed; wide group of society became the
health such as building of medical institutions, implementation of active players in the processes in society. Today disabled people
charity actions aimed at ensuring of one of most significant who were considered as forgotten group at one time are integral
human rights – right to health, protecting patients rights, reflect part of our society. Disabled people have freedom and personal
implementation of the universal bioethical principle of social immunity rights in society as each person.
responsibility and health. Various activities promoting cultural It is allowed and made opportunities to protect the disabled
dialogue, including organizing of different exhibitions, cultural people from discrimination, to expand the employment
festivals reflect the bioethical principle of respect for cultural opportunities, to study with other people and to realize their
diversity and pluralism. Projects in the field of social sphere and intellectual, creative, physical potentials as full‐fledged and equal
activities in the field of education and science, including building members of society, as well as most social welfares of disabled
of different‐type new schools, including boarding schools, people. There is law on disabled people, as well as relevant
kindergartens, secondary schools, reconstruction of the old official documents on social protection of disabled people. This
buildings of schools, can be considered as the implementation of law defines the state policy on disabled people in Azerbaijan. It
bioethical principles of human dignity and human rights, sharing ensures the participation of disabled people in economical, social
of benefits, equality, justice and equity and others. In recent and political fields of society life with other citizens.
years Foundation’s and Heydar Aliyev Center’s activities aimed at Disabled people in Azerbaijan have all social‐economical,
environment protection are increasing responding to Article 16 political, personal rights and freedoms stipulated in declaration
“Protecting future generations” and the Article 17 “Protection of of rights of disabled people adopted by UNO General Assembly,
the environment, the biosphere and biodiversity” of the in the Constitution of Azerbaijan Republic and other legislative
Universal Declaration on Bioethics and Human Rights. acts. Discrimination of disabled people in Azerbaijan is forbidden
and prosecuted by legislation.
Note that, Azerbaijan joined the Convention on “The rights of
HUMAN ENHANCEMENT AND NARRATIVE SELF disabled people” of UNO on October 02, 2008.

Anna Alichniewicz, Monika Michałowska It is defined the necessity of making opportunities to disabled
Medical University of Łódź, Poland people for having equal rights and executing these rights in most
anna.alichniewicz@umed.lodz.pl applicable legislative acts in Azerbaijan Republic.
Analysis shows that many works in the direction of the solution
In our presentation we address the alleged threat posed by of problems of disabled people were done, necessary legislative
human enhancement to personal identity. First, we analyze the acts served for the integration of society and the protection of
main meanings of human enhancement developed by its these people were improved, new laws, significant state
advocates and critics. The first meaning of human enhancement programs were adopted over the past period.
we present has been developed by John Harris in “Enhancing
evolution”, where he argues that human enhancement is
“change for the better” implied by a moral obligation of self‐ GENDER DISCOURSES AND BIOETHICS

improvement. An opposite view is claimed by Francis Fukuyama
Angela Aparisi
and Norman Daniels, who treat human enhancement as a threat
University of Navarra, Spain
to human nature that is our common heritage and therefore
aparisi@unav.es
should be protected. Also, in Habermas’ opinion human
enhancement threatens personal autonomy, since genetically The purpose of the paper is to present some of the contributions
enhanced people cannot consider themselves as “the sole of the gender discourse to the bioethical debate, specifically in
the field of nursing. At the same time, it will explain the quite a few clinical trials of drugs were done, because
contribution of the different feminist theories to the recognition pharmaceutical companies gave drugs, and there were no
and respect of human dignity. Basically, it will describe three alternative drugs available, and also the purchasing capacity of
fundamental models in the gender discourse: the egalitarian patients was too low to afford medicines. Formerly in the USSR,
model, the difference model, and the model of equality in nearly all analogues were manufactured in own factories,
difference (also called reciprocity or responsibility). The starting however, the factories were closed in mid‐90s, because they
point is that even though the first two models have made were not able to comply with GMP, were short of supplies,
significant contributions in the field of bioethics, they have equipment, financing. 90s and also the first five years of the 21st
nonetheless brought with them some deficiencies and century are also characterised by unobstructed collaboration of
reductionisms inherent in their thinking. The model of pharmaceutical companies with physicians, who were paid small
reciprocity, on the contrary, when properly understood, allows amounts of money for each prescription and given presents for
for the combination of the principles of equality and difference treating patients with specific drugs, and a blatant dictate of
between man and woman, which places it at a much more pharmaceutical sector in medicine.
enriching standpoint within the bioethical debate. The Helsinki principles established more firmly only in 2006‐2009
after the countries of Eastern Europe and the Baltics had joined
the European Union, when the European ethical standards
SOME OF MEDICAL ETHICAL ASPECTS OF emerged.
EASTERN EUROPE AFTER THE COLLAPSE OF THE USSR Since 1990, the life expectancy of the population of the Baltic
states has increased by 7.5‐9 years. The society is ageing, very
Peteris Apinis many young people are working in the Western Europe, birth
World Medical Journal of the WMA, Latvia rate has declined. The care for chronic patients dominates in
editorin‐chief@wma.net medicine, the causes of mortality are cardiovascular and

oncological diseases and accidents. The attitude of the
After the collapse of the USSR in 1991, a number of new
government to preventive measures has changed (success in
sovereigns were either founded or consolidated in Eastern
tobacco product restriction, encouragements to eat healthy
Europe, which until then were part of the USSR or the Warsaw
food). The awareness of patients has increased greatly. In the
pact. The former USSR countries were unified in their socialist
field of ethics, an informed patient has emerged who is further
economics and in the ideological USSR health care system
educated by the physician before starting a manipulation or a
headed by Semashko. As to the countries in Eastern Europe,
treatment. The main ethical problem in awareness is correct,
though governed by state capitalism, socialist economics and
accurate and unbiased information in electronic mass media, free
communist ideology, they still enjoyed somewhat more freedom,
of any influence from pharmaceutical companies and other
and also health care development allowed certain modifications.
groups with business interests.
Under socialist health care model, physicians’ training used to be
quite good, though concise (six years of study + one year in
internship according to specialisation field). To get qualifications

THE RIGHT NOT TO DIE: WHO DECIDES WHAT
of a physician was prestigious; therefore there was enormous
competition to get enrolled in study programmes. Indirectly, CONSTITUTES AUTONOMY, QUALITY OF LIFE AND
Stalin's belief was: “People will feed a good doctor, and there is FUTILE TREATMENT IN A CULTURE OF AGEISM

no use to pity a bad one”, therefore medical staff had very low
Rosalie Aroni
wages, keeping in back of the mind that doctors would receive
Monash University, Australia
direct, unofficial, yet quite legal payments from the patients.
rosalie.aroni@monash.edu
Lengthy in‐patient treatment was characteristic to socialism,
because hospitals also had a social function, especially in the cold Currently in Australia the discussions about potential legalization
season elderly and lone people stayed in hospital for months. of doctor assisted suicide have taken place within a set of
Stalin's medicine was subject to war‐time doctrine, when there is simplified narratives about “dying with dignity” with a focus on
high demand in mediocre‐trained medical staff, and this is why autonomy of the patient as the underlying ethical concern. These
the number of physicians and medical staff relative to the discussions have not only taken place in broad policy arenas,
number of population was much above the average figures in hospital boards and the media but also in faculties tasked with
Western Europe. educating the next generation of clinicians. The introduction of
The principles of medical ethics were guided by the paternal futile treatment policies and the marketing of “advance care
relationship between the doctor and the patient, which voiced directives” in Australian acute care public hospitals (predicated
“the doctor knows everything, and the patient is supposed to on quality of life and health care rationing arguments) has
take his pills”. Rather small notice was paid to prevention; use of framed both debate and research.
alcohol and smoking was openly propagated. At the same time, What has not been adequately investigated is the way in which
the socialist order assured a perfect prevention of diseases, e.g., such policies have been implemented either formally or
vaccination was done at nearly 100% rate, and any opposition to informally. Similarly, the views of patients with chronic illness
a child's vaccination could be a reason to invite a parent to and/or disabilities, their families and clinicians and the legal
security authorities in the capacity of a person endangering fraternity about such modes of implementation have not been
public order. critically examined.
This is the socialist past which lies in the foundation of ethical This presentation provides several case studies which highlight
problems we are facing in the post‐socialist environment at the the ways in which competing interpretations of quality of life,
beginning of the 21st century. The collapse of the USSR was resuscitation options and treatment utility are framed in
followed by an overall widespread economic crisis, leading to bioethics and sociological discourses which have underpinned
patients' treatment with medication and bandaging materials clinical and legal decisions. This includes the ways in which
donated as human aid. Computer tomography, radiological reason and ageism form part of these competing discourses and
diagnostic equipment was in every place: the equipment had how the key stakeholders view what constitutes reasonable
served is life in the Western Europe or the USA, and was evidence upon which to make such decisions. The relationship
removed and transported to Eastern Europe. In this situation,
between health care access, casemix funding and these middle years, the core bioethics will be taught. Integrated
competing framings of evidence is also presented. teaching‐learning methods shall be employed. The advantages
are minimal additions to the total teaching time, minimal
manpower needs and maximal efficacy.
LEARNING MEDICAL LAW AND BIOETHICS The resources: The manuals and booklets, prepared by the
THROUGH AN INTERPROFESSIONAL EXPERIENCE – UNESCO International Chair on Bioethics will be the mainstay.
THE ZEFAT LEGAL CLINICS PROJECT Further teacher manuals shall be prepared.
Evaluation will be a continuous process. In each of the university
Oren Asman papers of the various subjects, a few questions relevant to
Zefat Academic College, Israel bioethics, (within the subject matter of that field) shall be asked.
orenasman@gmail.com The relative quantum of the bioethics content within each
subject paper shall be minimal e.g. decorum within the anatomy
The "Zefat Patients rights legal clinic", is an Educational Program hall, surgical ethics in the surgery paper, etc. However, there
initiated at the Zefat Academic College Law school in must be one individual university examination in bioethics, after
collaboration with the Ziv Medical Center and the Technion the core bioethics had been taught, in the third year. The
Medical School ethics forum, now already in the middle of its marking schema shall focus on the concepts and not on the
fourth year of operation. factual knowledge. Internal evaluation (I.A.) shall be done, by
This program is based on an interprofessional collaboration of alternative methods of evaluation viz. assignments, seminars and
experts from the health field and from the ethical and legal fields. case studies. The attendance also shall be an essential part of the
This is done under the assumption that in the sphere of Medical I.A.
Law and Bioethics, collaborative work between Philosophers, This model had been seen by both the Asia Pacific Chair and by
ethicists, lawyers and health care professionals such as the International chair, and is currently being circulated to all the
physicians, nurses, social workers, hospital managers and risk chairs. Their critiques will be incorporated.
managers is an important factor in improving ethics based clinical
decision making and legal reasoning.
The program now operates using its unique instructive methods
DRUGS FUNDING AND RATIONALIZATION,
of “A shared learning community” and “field based inquiry”
IN HEALTHCARE SYSTEMS
which prove to be of important educational value.
The presentation refers to: Carla Barbosa
1. Outlines of the program, general topics and teaching University of Coimbra, Portugal
methods, target audience cbarbosa@fd.uc.pt
2. Short term and long‐term goals of this program and others
similar to it. In 2012, the Portuguese Ethics National Board for the Life
3. Evaluation of the program and its effectiveness over the past Sciences made public an opinion about the Drugs Funding and its
years. Rationalization in the Healthcare System.
Based on this description, we conclude that such programs are of Nowadays, in order to have legitimacy in a Healthcare Policy, it is
importance, not only for the students attending but also to the necessary to make priorities explicit at the planning and
professionals collaborating as teachers and guides, and to the implementation of those policies (Williams, 2012).
promotion of an inter‐organizational collaboration between their The Price evolution of drugs, medical interventions, and additional
respective organizations. diagnostic methods has set challenges on the potential earnings on
Health and on the constant costs growth. Therefore it is crucial to
implicate all the health professionals and researchers, around
A VERTICALLY INTEGRATING MODEL FOR TEACHING guidelines to set priorities (Gibson et al., 2004).
BIOETHICS TO UNDERGRADUATE MEDICAL STUDENTS This is a very serious issue in Portugal and in some European
countries, aggravated by the existing crisis.
D. Balakrishnan1, P. Thangaraju1, Russell D’Souza2 The debate about drugs costs and drugs prescription restrictions,
1
UNESCO International Chair on Bioethics, SRM University, India it´s a growing problem that has been intensified among the
2
Asia Pacific Chair, UNESCO Bioethics Network Health professionals, and among the public debate. It is urgent,
dean.medresearch@srmuniv.ac.in, balaent@gmail.com the creation of a decision model based on the principle of justice,
which protects the dignity of both the healer and the healed.
The patient‐doctor relationship, traditionally, used to be one of
mutual trust. Over the years, the focus has shifted to greater
accountability. The medical student must learn to identify the
DECISION MAKING IN SETTINGS OF UNCERTAINTY
ethical issues, and apply the fundamental principles. The current
medical curriculum is already packed fully. There is little time Terry R. Bard
available to teach bioethics. This model is a humble effort Harvard University Medical School, USA
towards elimination of the some hurdles of implementation. Terry_Bard@hms.harvard.edu
The Syllabus of our model follows the Bioethics Core Curriculum
UNESCO 2008 ver 1. The entire curriculum is divided into five Increasingly decision making in both industrial and clinical
units viz. 1.Introduction to Bioethics, 2. Core Bioethics, 3. Current settings is becoming linked with reductionist models influenced
perspectives, 4. Bioethics in Specific Clinical situations and 5. by statistical analyses often based upon primary and commonly
Applications and practicum. accepted ethical values. As utilitarian as such models might be,
The curriculum is designed to integrate with the existing they do not capture the dynamics of decision‐making that can
curriculum, vertically into each year of medical study. The lessons confound even the most well‐intended reductionist models. This
start from the first day of entry into the medical school. As the presentation will identify many of the complexities inherent in
regular medical curriculum progresses through the individual decision‐making processes urging greater attention to the
subjects in each year, the bioethics portions of each subject will individual psychological and philosophical aspects that attend
be taught by the regular teachers of the same subject. In the almost every decision.
POLITICAL HUNGER STRIKES AND FORCE‐FEEDING: regarding their perceptions of autonomy and human dignity in
AN ALTERNATIVE VIEW the context of treating patients with dementia. Our results show
substantial differences regarding the concept of human dignity
Yechiel Michael Barilan and the extent to which it is developed when comparing nurses
Tel Aviv University, Israel and other professional caretakers that migrated from Russia with
ymbarilan@gmail.com Arab nurses and other professional caretakers. Thus, whereas

this concept seems to be very developed and referred to among
Hunger Strikes (HS) have always been considered as a non‐
Arab nurses and professional caretakers, it is nearly absent
violent political toll to achieve some results from a condition of
among the nurses and caretakers that migrated from Russia.
weakness. In cases of imprisonment this is even more evident, as
Additionally, the study shows certain differences between both
those individuals involved in the practice have an extremely
of these groups and secular Jewish professional caretakers born
limited room for expressing their dissent. Examples like that of
In Israel. Finally, the study shows fewer differences between
Gandhi have provided the collective imaginary that HS are the
these 3 groups regarding the concept of autonomy and its
ultimate method of engaging into a political battle without
utilization. By exposing the varied viewpoints regarding human
putting at risk anybody else but the hunger strikers. As a result,
dignity among the three aforementioned groups, this study may
any attempt to force‐feed those political activist has been
enrich the liberal‐mainstream conception of human dignity, while
labelled as against the right of the prisoners to affirm their
stressing the need to augment possible deficiencies in the
autonomy. In this presentation, I will challenge such a position by
comprehension and utilization of this concept among
providing arguments that will support the force‐feeding of
professional caretakers from other groups (e.g. professional
hunger strikers in prisons as a morally sound alternative.
caretakers migrated from Russia).

AN OVERVIEW OF THE NEEDS OF RESEARCH DATA ABOUT TEACHING BIOETHICS
TECHNOLOGY‐DEPENDENT CHILDREN IN 2015 THROUGH CINEMA AND TELEVISION SERIES: HOUSE MD

Eliezer Be'eri
Moty Benyakar1, Irene Cambra Badii2, Juan Jorge Michel Fariña2
Alyn Hospital, Israel 1
Universidad del Salvador (USAL), Argentina
ebeeri@alyn.org 2

University of Buenos Aires, Argentina
The population of children who are dependent on technology to motybenyakar@fibertel.com.ar

maintain health and facilitate participation in society today has
This paper presents the results of the first PhD Thesis result of
grown far beyond the four medical conditions and technologies
rigorous research on the subject. This is an analysis of the main
(mechanical ventilation, parenteral nutrition, renal dialysis and
articles of the Universal Declaration on Bioethics and Human
plasmapheresis) that originally defined "technology dependence"
Rights through its manifestation in the most popular medical
when the term was first introduced in 1987. Today the term
series in the world. 166 selected episodes of the medical drama
includes, in addition, a wide spectrum of neuromuscular
House MD were distributed among 245 students. They worked
disorders, as well as disorders of vision and communication, with
on these selected episodes, establishing a theoretical synthesis
their attendant technologies. This review will describe the
and articulation work. Then, the same students defining
spectrum of conditions and technologies encountered by
situations (in the manner of vignettes) where they could locate a
healthcare providers who treat technology‐dependent children
possible bioethical problem. 1340 vignettes were defined in total.
today, with a focus on the technical, emotional and psycho‐
The analysis of this vast material allowed to demonstrate the
developmental needs of these children and their families.
double articulation of ethics. On the one hand the deontological
Examples of contemporary technologies used for facilitating
dimension and on the other hand the singularity as its appear in
mobility, communication, mechanical ventilation and activities of
each case.
daily living will be shown, and a conceptual model for holistically
identifying the needs of technology dependent children will be
presented.

DILEMMAS CONCERNING CUSTODY FOR HIGH CONFLICT
DIVORCE WITH A FOCUS ON EARLY CHILDHOOD

TREATING DEMENTIA AND MULTICULTURALISM: Iris Berent
EXPLORING THE PERCEPTIONS OF MULTICULTURAL Israel
PROFESSIONAL CARETAKERS IN ISRAEL REGARDING berenti@012.net.il

AUTONOMY AND HUMAN DIGNITY
The effects of divorce on the social and emotional development
Miriam Bentwich1, Amitai Oberman1,2, Nomy Dickman1 of children are in high priority and as the amount of children who
1
Bar‐Ilan University, Israel are affected since their early childhood by parents who were
2
Poriah Medical Center, Israel separated is increase and the portion of affected children is
Miriam.Bentwich@biu.ac.il bigger if we are taking into consideration children's parents
separated without getting divorced.
Treating patients suffering from Dementia brings up the tension Joint custody reflects the changes in society. Like many other
among the principles of autonomy, human dignity, beneficence countries, Israel also went through changes in the division of labor
and non‐maleficence. Most of the literature in this area is based within the family: mothers work more outside of home and fathers
on a Western‐liberal perspective, so that it does not include make more efforts in child care. These changes had been dealt at
representation of non‐Western viewpoints and their application the legislative level in the so called "Divorce Laws Revolution"
held by multicultural professional caretakers of demented which started in 2005 with the establishment of the Committee for
patients in Israel. We present here the results of a qualitative Examining the Legal Aspects of Parental Responsibility in Divorce
study, utilizing content analysis of interviews done with 20 ("The Shnit Committee"). Recommendations regarding the best
nurses, social workers and other professional caretakers custody arrangements for very young children are complex and
depend on the studies and theories of child development. The By lack of any real analysis of the socio‐economical impact of the
situation is further complicated when parents cannot introduction of a research agenda or technologies in contexts of
communicate without making the children the victims of their scarcity, emerging countries, which have no capacities to host
quarrels. What is the best interest of the child when parents are in them in a situation of minimal symmetry, are bound to exchange
conflict and unable to communicate? Why parents who are economical alienation for a form of development that brings
concerned about their child's best interest find it difficult to focus knowledge alienation and dependency.
on it clearly? What are the conditions required in order for a This recurrent debate is very problematic. It has been discussed
couple to put their conflict aside and the best interests of the child mostly in terms of Anglo‐Saxon liberal political models, often
at the center? I shall offer two main directions of coping with these confusing the notions of capacity building and capabilities, as
questions: 1. Psychological education that teaches parents to perceived by the agents themselves. I will analyze from these
separate between parenthood responsibility and parental conflict perspective how to avoid what I call "the violence of
2.Systemic understanding as a means to identify the hidden benevolence".
strategies which increase the conflict and constitute a basis for In order to analyze some empirical situations in bioethical
effective interventions and recommendations regarding custody discourse, and the evolution of mentalities in “traveling
and treatment. experiments” I will propose resistance as a new form of
narrative. I will argue why this resistance it requires an innovative
model of judgment.
THE ROLE OF THE PHYSICIAN IN "REALITY TV"

Malke Borow, Leah Wapner DO QUALITY IMPROVEMENT (QI) ACTIVITIES NEED
Israeli Medical Association, Israel
APPROVAL BY INSTITUTIONAL REVIEW BOARD (IRB)
michelle@ima.org.il; abbey@ima.org.il
OR ARE THEY AN ETHICAL OBLIGATION INHERENT
The phenomenon of "Reality TV" has become prominent in TO ANY CLINICAL ACTIVITY?
recent years. Although the ethical issues with such programs are
plentiful, there are also issues specifically related to medical Mayer Brezis
ethics, such as: is it ethical to perform plastic surgery on Hadassah Hebrew University Medical Center, Israel
television? When and how should a physician treat participants brezis@mail.huji.ac.il

of such programs? Although the American Medical Association Activities of quality and safety in healthcare aim at monitoring
has had ethical rules regarding reality TV since 2005, the issue performance of services, comparing and improving them, as well
arose in 2012 in Israel when charges were raised that a reducing errors. Scientific rigor (for validity and reliability) and
psychiatrist employed by the broadcaster prescribed psychiatric publication (for benchmarking, public transparency and sharing
drugs to participants of one such show. ideas for improvement) make these activities similar to other
In response, the Israeli Medical Association ethics committee met types of research – and thereby currently requiring IRB approval.
and formulated a series of guidelines on this very current and QI starts by acknowledging imperfections in the current situation:
controversial topic. The committee found that contestants on “any defect is a treasure” (slogan of the Japanese industry).
reality TV are under pressure and deprived of important Conflicts may therefore arise when senior executives in the
information in order to heighten the element of surprise, and organization prefer to hide the problems to preserve façade in
therefore can't give proper informed consent. The committee media coverage. We observed misuse of IRB to limit quality and
formulated a set of rules designed to protect the contestants' safety activities perceived as potentially damaging to institutional
health and well‐being, including ensuring that they are physically image – culminating in an attempt to close down our unit of
and psychologically fit; monitoring their condition throughout Clinical Quality and Safety. Moreover, as journals require IRB
and for a short time afterward, and requiring that physicians approval for publication, we also witnessed rejection of a paper
affiliated with the show should be independent. This will ensure on safety because of missing consent by physicians to
that the physician's first priority is the contestants' health and observations, as if, for instance, monitoring of team adherence to
not ratings. S/he will be the sole arbiter of whether the hand hygiene should require their prior approval. Most editors
contestant is physically or mentally fit to continue on the show. do not understand those issues and have not yet developed
The guidelines issued by the committee reflect ethics of a appropriate policies for the ethics of QI.
changing culture and will undoubtedly be tested further in the A leading group of ethicists, clinicians and scholars convened by
coming years. the Hastings Center concluded: QI activities should not undergo
review by IRB but rather be part of professional supervision of
clinical practice (Ann Intern Med. 2007;146:666).
CAPABILITIES AS A CHALLENGE TO JUSTICE AS EQUALITY, We propose that QI activities are an ethical obligation for any
HELSINKI'S REVISIONS AND THE VIOLENCE OF healthcare service. A regulatory reform of ethical requirements in
BENEVOLENCE healthcare is in order in primary legislation.

Mylene Botbol Baum
UCL, Belgium
BELGIAN MUSLIMS AND END OF LIFE ETHICS
Mylene.botbol@uclouvain.be

Bert Broeckaert, Chaïma Ahaddour, Goedele Baeke,
The theoretical debate over capabilities and capacity building, in
Stef Van den Branden
a world that often confuses the private and the public, makes of
KU Leuven, Belgium
bioethics the acclimatization garden of new forms of discourses,
Bert.Broeckaert@theo.kuleuven.be
which are often globalized without empirical perspective on how
to realize social justice in modern medicine. In a global world Background: In just a few decades Islam has become the second
where experimentation is often exported the dilemma for largest religion in most European countries. This evolution
assuring decent minimum of health care to participants of constitutes an important challenge to European health care
research can be acute.
(including palliative care), as this is still deeply influenced by human moral capacities, we must have some “objective” picture
secular‐Western and/or Christian approaches. of ideal (virtuous) human being. That ideal must have some
Aims: Part of the exploratory research programme (2002‐2014, 3 objective features that are subject of human knowledge. That
PhDs) presented here aimed to analyse real world end of life picture of the ideal man is nothing else than the goal or purpose
views and attitudes of elderly Muslims in Flanders, Belgium. of moral enhancement. Like in metaethics, prior theoretical
Methods: Semi‐structured interviews with elderly Moroccan men discussion (here in the triad utilitarianism‐deontology‐virtue
(20 interviews), elderly Turkish and Moroccan women (60) and ethics) is still in progress without any obvious resolution on the
specialists (20). All interviews were transcribed, coded and horizon. Nobody has presented why virtue ethics is the best
categorized using Grounded Theory methodology. model for bioethical researches, yet. However, that normative
Results: Euthanasia and assisted suicide are strongly rejected; dispute in has to be concluded before applying of its results
non‐treatment decisions and the refusal of treatment are only further.
allowed in exceptional circumstances; pain control does not pose Finally, metaphysical presupposition of moral enhancement
an ethical problem. God controls illness and health, life and seems to be that only humans could be moral agents and,
death; it is unacceptable to interfere in this divine plan. Patience consequently, subject of moral enhancement. Furthermore, it
is the central virtue. We found hardly any differences between seems that very idea of moral enhancement brings us to the idea
the guidelines in the international normative Muslim sources and of morally perfect man. That man cannot make moral mistakes. If
the actual attitudes of our respondents. this idea is an implicit in enhancement thesis, please let us
Discussion: The attitudes of the generation of Belgian Muslims remember supercomputer HAL 9000 from Stanley Kubrick’s
studied here are deeply influenced by a shared religious classic 2001: A Space Odyssey. First of all, HAL is not a human.
framework. Nevertheless, even in these very homogeneous Second, HAL has not become a moral being because it (he? she?)
groups a few dissident voices were found. In palliative care it is “enhanced”. By definition, HAL is perfect and cannot be
remains essential to start from the ethical and religious views of “enhanced”.
the unique individual in front of you; not from the views that are That finally means that HAL becomes moral exactly at the
typically associated with the community he/she belongs to. moment when he becomes capable of evil.

HUMAN ENHANCEMENT AND MORALITY: SOME DOUBTS BIOETHICS AND THE HOLOCAUST:

TEACHING LESSONS FROM THE PAST
Nenad Cekić
FOR FUTURE HEALTHCARE PROFESSIONALS
Belgrade Faculty of Philosophy, Serbia
ncekic@f.bg.ac.rs; n.cekic@sezampro.rs; crveni@sezampro.rs Tessa Chelouche

Clalit Health Services, Israel
The apparent tension between the idea of bio‐technological or
tessa.chelouche@gmail.com
medical moral enhancement and the concept of freedom is a
result of three overlapping implicit premises hidden in the very When reflecting upon medicine and the Third Reich and the
notion of moral enhancement. First is metaethical, second Holocaust, we encounter some of the most difficult and profound
normative and third metaphysical. choices of our humanity. Medical practice during this era
Metaethical presupposition behind idea of human moral provided the basis for the present bioethical doctrine.
enhancement is pretty straightforward. If we believe in the Consequently, it is safe to state that this subject does not belong
possibility of artificial improvement of human moral behavior, we to history but rather, as I believe, to the future. Discourse on the
must belong to some group of metaethical descriptivists or lessons that can be learned from the practice of medicine during
cognitivists. The central thesis of traditional cognitivism is that the Third Reich and the Holocaust should be an essential
ethical judgments can be either true or false in the fashion on component of all healthcare professional education.
scientific or empirical statements are. Why are proponents of With this in mind, under the auspices of the International Center
bioethical enhancement almost necessarily metaethical for Health, Law and Ethics at Haifa University and the Israel
cognitivists? They are cognitivists because improvement of any National Commission for UNESCO and the Israeli Head of the
human capacity presupposes objective knowledge about that Chair of Bioethics, Professor Amnon Carmi, I together with
capacity. Hence, enhancement of human moral capacity Geoffrey Brahmer and Susan Benedict, have published a
presuppose objective knowledge of what “to be moral” casebook using personal cases from the Holocaust on various
descriptively mean. In short: ethics must be either science or some bioethical issues that are relevant and pertinent to today's
branch of a priori knowledge, similar to mathematics or logic. The bioethical discussion. The various aspects of medicine during the
real problem is that cognitivism/non‐cognitivism dispute in Third Reich are demonstrated, reflecting both the perpetrators
metaethics is far from being settled, and there is a strong and the victims, and include cases of both Nazi physicians and
possibility that it ever won’t be resolved. However, philosophy is prisoner physicians. Each case is accompanied by an historical
full of unsettled problems, and that is nothing new. On the other background in order to provide the correct social context and a
hand, cognitivistic idea of objective moral knowledge similar to wider perspective on the issue. This is followed by an ethical
scientific inquiry is in direct opposition with ideas of freedom and discussion whose aim is to provide a tool for reflection and
choice. For example, if we always (could scientifically?) know what dialogue on bioethical issues both in the Holocaust, and in our
course of action is right – where is the room for choice and own times.
freedom? This thesis is not a plea for moral relativism but rather Greater knowledge and ethical discussion on these profound
attempt to point out that foundation of morality could or even issues can not only help combat ignorance and prejudice, but can
should not be found in literally perceived “science”. also inspire healthcare professionals to practice with greater
Normative problem of moral enhancement is quite similar to compassion, knowledge, tolerance, respect and justice on behalf
metaethical one. Idea of moral enhancement forces us to take of their patients. Moreover, we believe that by promoting
one very distinct normative side. A proponent of moral education on the medical discourse of the Holocaust we can
enhancement must show that virtue ethics is a correct (true? inform the students on human and scientific values that will be of
scientific?) normative ethical theory. Like in metaethics the great value to their future lives and careers.
reason for this is almost obvious. If we would like to enhance
In this presentation I shall demonstrate how these cases can expression may adversely affect patients’ trust in doctors and
serve as a platform for present and future bioethical education. respect for the profession?
Ethics Committee members were asked to find the middle ground
between the realization of the right to freedom of expression and a
NATIONAL ETHICS COMMITTEE ON HIV/AIDS – doctor’s duty to protect the dignity of the profession.
THE ISRAELI EXPERIENCE The committee agreed to the following principles:
1. Doctors have the same right to freedom of expression as any
Daniel Chemtob1, Avigdor Salton2, Efrat Haddad1, other citizen of the state.
3 2 4
Estelle Rubinstein , Yifat Aharon , Israel Yust 2. It is recommended that a doctor consider his comments when
1
Ministry of Health, Israel expressing himself in the media and in general.
2
National Ethics Committee on HIV/AIDS, Israel 3. The doctor will be responsible, considerate, respectful and
3
Hadassah University Medical Center, Israel tolerant in general and when speaking to the media in
4
Tel Aviv Sourasky Medical Center, Israel particular.
daniel.chemtob@moh.health.gov.il 4. The doctor will speak with restraint in every framework

related to his profession or workplace.
Background: Prevention, diagnosis, notification and treatment of
5. The doctor will not abuse his position when he voices his
people living with HIV (PLWHIV) often raise important ethical
opinions, as if the opinions are based on his medical knowledge.
dilemmas for health care workers (HCWs) that apparently conflict
with human rights or public health. Therefore, a "National Ethics
Committee on HIV/AIDS" was established in 2005 (under Section

THE PRINCIPLES OF FAIRNESS AND JUSTICE IN FORENSIC
20 of the Israeli Patient's Rights Act, 1996). Accordingly, any HCW
as defined by the act or any interested party can apply to the INVESTIGATION AND IDENTIFICATION WORK ANALYSIS

Committee. Wen Wu‐Bei Chen, Sheng Gao, Kai Liu, Shu Bo‐Qing Huang,
Objective: To analyze the types of requests brought before the Tao Wei, Zhen Li
Committee, and their outcome. Kunming Medical University, China
Methods: All requests received in 2005‐2012 by the Department 1070016521@qq.com
of Tuberculosis and AIDS were analyzed according to
demographics, HIV transmission groups and nature of requests. Objective Understanding and view of forensic ethics principles of
Results: Thirty‐three cases (M/F=1.75) were presented. Mean fairness and justice in the on‐the‐job police in Yunnan province.
age for males: 37.7 years; SD: 8.4; range: 19‐50; for females: Put forward some preliminary discussion.
mean: 31.1; SD: 6.6; range: 19‐47. Numbers of cases per HIV Method Using cluster sampling method to carry on the
transmission groups were: 22 (66.7%) Israelis of Ethiopian origin; questionnaire survey to the police in some areas of Yunnan
4 (12.1%) other Heterosexuals; 5 (15.1%) Men who have Sex with Province behavior in his work, the investigation time for one
Men; and 2 (6.1%) Injecting Drug Users. The reasons HCWs year. Statistical methods are descriptive statistics, logistic
requested a meeting were: disclosure of HIV to sexual partner regression analysis.
(75.8%); "protecting Public Health" (12.1%); HIV testing/ Results (1) for the simple folk area handling cases, accounting for
treatment for fetuses/newborns of HIV+ mothers (9.1%); non‐ 89.1% of the work need to be more careful (2) in the
adherent patient (3%). Eight (24.2%) requests were beyond the investigation of the police group, do not agree to give the
committee's statutory jurisdiction. Among the 25 remaining appraisal conclusion of vulnerable groups is slightly biased
cases, 19 (76%) were summoned to the committee and resolved accounted for 91.3%.
without further procedure (five of an unknown outcome), and 6 Conclusions In the process of judicial appraisal of forensic
(24%) cases were resolved before the committee convened. medicine involves ethical issues related to the principles of
Conclusions: Despite complex socio‐cultural issues, the fairness and justice, need to pay attention to, research on
Committee assisted in successfully mediating between PLWHIV forensic medicine and investigate the cause of all. At the same
and HCWs facing ethical dilemmas. time in the reality of daily work, identification of disputes related
to forensic workers should pay attention to ethics problems
caused by the need to continue to strengthen the consciousness
FREEDOM OF EXPRESSION VERSUS RESPECT FOR THE of justice, fairness.
PROFESSION

Baruch Chen, Elinor Goshen, Tami Karni ON ETHICAL PLACES: THE PRACTICE OF
Israeli Medical Association, Israel ‘TERMINAL DISCHARGE’ IN CLINICAL SETTINGS
michelle@ima.org.il; Karen@ima.org.il

AND THE GOOD DEATH IN TAIWAN

During the tumultuous period following the deaths of three
Yicheng Chung
Jewish teenagers and one Arab teenager in Israel, and continuing
Ritsumeikan University, Japan
with the conflict in Gaza, the IMA Ethics Committee addressed
yichengchung@gmail.com
several complaints regarding political or social policy statements
made by doctors who expressed their views publicly, either in In discussions of end‐of‐life care, the place where one wishes to
print and electronic media or the internet in general. die is thought to be as one of the deciding factors in
Complaints received by the Ethics Committee concerned the considerations of quality of life. In Taiwan, the place of dying is
ability of these physicians to give the best professional care to related to not only the quality of life, but also the quality of
everyone, in light of the statements they had made. The Ethics death. There is a strong belief about home death and its relation
Committee addressed whether they could make a to the good death, and a customary practice in end‐of‐life care is
recommendation in favour of restricting freedom of expression derived from such belief. The so‐called ‘terminal discharge’ is a
based on these concerns—after all, isn’t free expression part of practice which discharges dying patients on patients’ or family
civil conduct in a democracy? What happens when a form of free members’ wishes, and arranges private ambulances to take
patients home and die there. This indicates how medical
practices accommodate themselves to the cultural beliefs about medical teams in France. After having defined the “research
life and death in Taiwan, and the transference from hospitals to with”, the presentation will propose reflection about the
home suggests ethical considerations in the place of dying in confrontation between a qualitative research protocol and an
Taiwanese society. objectivist and utilitarian conception of the “procedure ethics”,
Based on the practice of terminal discharge, this presentation will ethics that would be at the service of instrumental rationality (de
address a relationship between place and ethics in end‐of‐life Gauléjac, 2009) and would limit the creativity of the protocol the
care in Taiwan from three parts: 1) the guidelines and legal “research with”. This presentation will bring to light disciplinary
regulations concerning the practice; 2) the traditional beliefs and epistemological tensions between social sciences research
about good death and places of dying in Taiwanese society; 3) and biomedical research. We will talk about the difficulties that
the concept of ‘ethical place.’ The aim of this presentation is to researchers are faced with as well as the strategies and
elaborate the concept of ‘ethical place,’ which suggests different workaround solutions. In the context of procedural ethics, we will
ethical rules may apply in different places, and by using show how the “research with” logic, that consists of adapting the
ethnographic data, to give a full picture of the development of protocol to the realities on the ground, gives way to the one of
end‐of‐life care in Taiwan. normal standard with conditioned effect on the production of
knowledge.

THE ETHICAL CHALLENGES OF CONDUCTING A
POPULATION‐BASED SCREENING FOR THE ETHICS OF CLINICAL JUDGEMENT AND MEDICAL
NON‐COMMUNICABLE DISEASES IN A SETTING WITH INTUITION IN THE WRITINGS OF MOSES MAIMONIDES

LIMITED UNIVERSAL HEALTH COVERAGE

Kenneth Collins
Fatima L. Ciroma, MA Kana, F Adiri, MS Yusuf, Hebrew University of Jerusalem, Israel
OM Avidime, A Abdulrazak, MN Sada Drkcollins@gmail.com

The contemporary practice of medicine is increasingly governed
fatimaumaralkali@ymail.com

by clinical guidelines based on evidence derived from
Background: Many developing countries with high disease scientifically valid criteria. While scientific knowledge remains
burden have inadequate universal health coverage. In this crucial in achieving clinical improvement, doctors still need good
setting, epidemiological screening is constrained by ethical communication skills, ethical sensitivity and a humane attitude.
dilemma for investigators. On one hand, the screening confers Without the appropriate interpretive skills and the insights of
awareness for participants. But factors like limited availability good clinical judgement a comprehensive approach to patient
and costly healthcare services reinforce the unwillingness of the care may not be possible. Clinical judgement thus has scientific
screened participants to seek and utilize the available healthcare and ethical components, reflecting both the modern medical
service on a sustainable basis. This paper aims to describe the technological base and the historic medical art. The recent
experience of a population‐based hypertension and obesity emergence of a movement promoting the ‘medical narrative’ in
screening survey in northwestern Nigeria. the patient’s illness gives space for the insight that is required in
Method: A cross‐sectional descriptive study was conducted on understanding the patients’ health issues, eliciting the patient’s
1,900 University staff and students that are not covered by the often hidden emotions and understanding their cultural, religious
National Formal Sector Social Health Insurance Program. The and personal sensitivities. It reclaims the centrality of the doctor‐
WHO Stepwise protocol for the screening of non‐communicable patient relationship in the clinical encounter.
disease was employed. It begins with obtaining informed consent Clinical judgement involves the traditional processes of
from all participants, and then questionnaires administered, observation, investigation, diagnosis and treatment. Intuition,
anthropometric and blood pressure measurement done. once seen as critical in a physician, has given way to scientific
Participants with abnormal findings were counseled and referred advance but can still have a role in providing the context for the
to the hospital for clinical management. Subsequently, we clinical knowledge and ethical values of the physician. Such
conducted an awareness seminar for all participants. values have a long history and can be identified in the writings of
Results: The age of participants ranged from 16‐67 years great physicians of the past. This paper will follow the guidance
constituted by 36.6% and 63.4% respectively of females and of Moses Maimonides (1138‐1204) who saw his medicine as part
males. The prevalence of systemic hypertension was 7.4% with 9 of the knowledge base of the philosopher, giving the practical
participants severely hypertensive, while 21.9% were either application of the physician’s craft the necessary intellectual
overweight or obese and 13 of them extremely obese. underpinning. Thus, judgement and intuition become key
Conclusion: Our findings highlight the ethical challenge of the components in the ethical care of the patient by the
role of researchers as observers during observational studies on compassionate and competent physician.
participants with limited healthcare access. It is recommended
that epidemiological screening surveys in similar settings should

have adequate arrangement for referral of participants with REPRODUCTIVE ETHICS, RIGHTS AND EVOLVING
pathological diagnosis. ISRAELI LEGISLATION

Yardena Cope‐Yossef
ITIM – Jewish Life Advocacy Center, Israel
PROCEDURAL ETHICS: TENSIONS BETWEEN SOCIAL
jordannalcope@yahoo.com
SCIENCES AND BIOMEDICAL SCIENCES

"The Right To Bear Children Through ART" is a right whose
Séverine Colinet
definition and boundaries are debated throughout the world. The
University of Cergy‐Pontoise, France
results of those debates ultimately inform the legislation in
severine.colinet@u‐cergy.fr

countries around the world. New definitions of what constitutes
The presentation will aim to explain the stakes at the beginning a family and the value a particular society attaches to natalism
of a research that involves a social sciences team and five also have a decisive impact on that society's norms and laws. In
Israel the director general of the Ministry of Health appointed THE RIGHTS OF THE CHILD: A WELFARE PRINCIPLE
the Mor‐Yossef committee to conduct in an‐depth investigation APPLIED TO CHILDREN BORN IN TRANSNATIONAL
of societal norms, values, ethics and rights vis‐à‐vis reproductive SURROGACY ARRANGEMENTS
technologies and surrogacy, and in 2012 the committee
published a report addressing the comprehensive picture of Marsha J. Tyson Darling
optimal Israeli legislation. This presentation will present a few Adelphi University, USA
landmark cases decided before or parallel to the committee's darling@adelphi.edu
hearings, key findings and recommendations of the committee's
report and the emerging case law and legislation based on the Children are the reason there is a growing transnational fertility
report. Key questions that will be addressed: what is the extent industry. My presentation applies a welfare principle, integral to
of the "right" to parent through ART recognized by the Hague legal standards regarding the paramountcy of the best
committee and what ethical principles and considerations interests of the child, to the complex set of issues related to the
informed the recommendations of the committee? Lastly – to global commercial fertility industry’s main enterprise—baby
what extent are those being implemented and to what extent are making. My comments will explore how a welfare principle
they being overridden by competing values and ethical applies to infants born into and adopted through the agency of
considerations? cross‐border surrogacy arrangements. In this vein, while many
infants born via transnational gestational surrogacy
arrangements—especially where the intended parents have
contracted with a poor woman in a low resource country (i.e.,
ETHICAL DILEMMAS IN THE ELECTRONIC MEDICAL ERA:
India, Thailand, or the Ukraine)—accompany the commissioning
AN INTER‐RELIGIOUS COMPARISON

adults who have paid for them safely back to the nations they
Yitschak Copperman will call home, an increasing number of newborns are caught in a
Israel legal quagmire and are denied admission to the home country of
issacc@smile.net.il the intended parents. My comments will provide examples of
how immigration officials, the courts, and policymakers are
The ability to prolong life by electronic medical equipment has negotiating the political, legal, and ethical terrain between claims
presented to us new ethical dilemmas that were not seen in for expansions of the reproductive freedom of adult citizens on
previous generations. the one hand—and securing the well‐being of infants born
A middle aged man had a pacemaker inserted. Over a period of through transnational gestational surrogacy. A second focus of
time, his mental condition degenerated to the extent that he was my comments explores the “right” of a child to know of its birth
unable to recognize his own wife and children. Physically, he was ancestry in the context of the expansion in the use of assisted
strong and healthy and had a life expectancy of many years. reproductive technologies.
Without his pacemaker, he will die. When the battery starts to
weaken, should it be replaced, or rather let nature take its
course? BIO‐ETHICAL ISSUES CONCERNING CLINICAL
An elderly man had a defibrillator inserted to prevent sudden NEUROPSYCHOLOGY IN GENERAL, AND MAINLY IN
cardiac arrest from dangerous heart arrhythmias. As his general
DAMAGES CLAIMS IN CASES OF BRAIN INJURY
condition deteriorated, he was concerned that when he "died",
the device would continue to resuscitate him, and not allow him Chanan David
to die in peace. He asked his cardiologist to externally Israel
electronically deactivate the device. This would prevent the chananda@zahav.net.il
device giving him an electric shock if he had an arrhythmic
cardiac arrest, and not prolong his suffering artificially. The Clinical Neuropsychology actually deals with one of the most
These real life cases were presented to authoritative complicated issues in the domain of bio‐ethics – since in both its
representatives of the Jewish, Muslim, Christian Catholic and conceptual and 'practical' aspects it is posed in the shadow, or
Protestant faiths. Their attitudes, points of agreement and rather in the light, of the enigmatic psycho‐physical problem –
differences of opinion will be the subject of this paper. that is the unsolved issue concerning the relationship between
the brain, and the mind of the "owner of that brain". One arena,
in which both neuroscience and psychology – and specifically
A REVISED ETHICAL CODE FOR AN ASSOCIATION OF neuropsychology – meet is the court; for example, in cases of
damage claims of brain injuries.
MENTAL FIRST AID
The neuropsychological opinion which might be essential, in such
Shiri Daniels, Tal Peri, Lidia Sela, David Koren cases, is based on qualitative analysis of the results of
The Israeli Association for Emotional First Aid (ERAN), Israel appropriate psychological tests taken by patients, and on a
shiri@eran.org.il proper differential diagnosis. These two procedures as well as
dealing with the causal effect concerning the disorders that were
ERAN, the Israeli Association for Emotional First Aid by the found, might pose an ethical problem of their own.
telephone and the internet, is revising its ethical code. The need
for the revision came from several changes that occurred since
the past code was formed, including technical advances, practice LESS TALK – MORE ACTION:
modifications, and social changes.
TEACHING ETHICS TO GENERATION Y
A committee for the code's revision was formed, and the revision
relates to several aspects of the telephone and internet "hot Zahava Davidow
lines" services, including: conduct and misconducts – borders and University of Haifa, Israel
limits of the calls; anonymity – of the clients as well as of the zdavidow@research.haifa.ac.il
responders; quality control, and risk management.
The revised code will be discussed, and comments from the Teaching ethics to today's health science students must be done
audience will be appreciated. differently than in the past. Out with frontal lectures and long
reading assignments, and In with movies, interesting cases, peer Science) in bioethics. The “List of Scientific Specialties” does not
interactions, and fun tactics. include bioethics.
Today's students are people of "Generation Y". They learn best
by multimedia formats, case presentations, audience
participation, and group discussions. VIEWS ON END OF LIFE SITUATIONS AS EXPRESSED
This lecture presents didactical methods in teaching ethics to BY FIRST‐DEGREE RELATIVES OF
health science students. Methods that are interesting and PATIENTS IN A VEGETATIVE STATE
exciting. Methods that engage the students in the material, and
invite them to fall in love with the world of ethics. Ittai Dayan1, Esther‐Lee Marcus2, Uriel Heresco‐Levy2
1
The lecture will explore the following topics: Hadassah – Hebrew University, Israel
2
• Why we need to teach differently today Herzog Hospital, Israel
• How ethics can be taught so the students want to learn Gerontology.israel@gmail.com
• How ethics are being taught today to Physical Therapy
The increasing population of patients in a vegetative state poses
students in the University of Haifa
ethical, social, and cultural questions regarding indefinite
What do the Students learn using this teaching method?
maintenance of life in end‐stage disorders of consciousness.
• How to document a clinical situation in a clear, concise and
In our research, we aimed to identify and achieve a better
ethical manner
understanding of views on end‐of‐life situations as expressed by
• How to identify an ethical problem, and determine if it is an
first degree relatives of vegetative state patients in Herzog
ethical dilemma or an ethical issue and how it differs from a
Hospital, a long‐term‐care facility in Jerusalem. We interviewed
legal problem.
30 family members of 19 patients, hospitalized for a mean
• How to analyze an ethical dilemma through “Ethical duration of 30 months, regarding their views on intensive care, as
Reasoning”. well as palliative care that they personally would want to receive
• Ethical terms, principles, and values and how to implement in the case of terminal disease or permanent loss of
them when discussing ethical issues consciousness. None of the patients and only two relatives held
• The Professional Code of Ethics and how it can assist in advanced directives for end‐of life decision making.
understanding clinical ethical situations and in solving ethical We quantitatively collected the data and then correlated their
dilemmas opinions with different socio‐economic, religious, psychological,
• How to recognize and evaluate their own moral values and and pathological data, focusing on Complicated Grief Disorder
examine how they differ from their peers among the relatives.
Our findings show that views embracing the prolongation of life
under any circumstance are virtually identical in terminal disease
PROBLEMS AND PERSPECTIVES IN BIOETHICS EDUCATION and permanent loss of consciousness. Family views embracing
IN THE CIS COUNTRIES (SOCIO‐PHILOSOPHICAL ANALYSIS) prolongation of life are strongly and positively correlated with

higher levels of religiosity, and to a lesser degree with abrupt
S. Davtyan, K. Ghazaryan clinical deterioration of the patient and male gender of the
Armenia relative. Complicated Grief Disorder, while not influencing end‐
susannadavtyan47@gmail.com of‐life decisions, is highly prevalent and associated with greater

The higher medical education in all the CIS countries aims at burden on the relatives.
achieving three inter‐related and inter‐determined goals: We believe that under such circumstances family views and
1. To provide graduates with updated knowledge and skills on emotional reactions towards their loved ones situation should be
fundamental branches of medicine; taken into account.
2. To develop the ability for self‐education, their pursuit of new
knowledge and their self‐actualization in the chosen profession;

3. To create conditions for the development of a motivated, THE ETHICAL SIDE OF HEALTH TECHNOLOGY ASSESSMENT
dedicated and moral personality of a physician. (HTA)

Nowadays humanization of medicine and the search of new
models of medical education corresponding to modern Xavier Deau
requirements relating to the progress in scientific and social life is World Medical Association
very urgent. Inter‐relations of medicine and education acquire a international@cn.medecin.fr

new meaning due to the emergence of integrative concept of The technological progress is getting faster and faster with even
bioethics having a compound social and philosophical status. more efficiency. But at the same time, this could entail potential
Until now, there is no distinct opinion about who should teach drifts and diversions. Technological progress cannot be directly
bioethics to medical students: philosophers, physicians, jurists or applied to human beings. Contrary to technology which is related
other specialists. A special character for medical students implies to industrial processes, medicine is deeply rooted in individuals
an interdisciplinary aspect. There should be a proper balance with a profound and central human dimension. While talking
between applied profession biomedical ethics and fundamental about HTA, there is a subtle balance that must be found between
moral and philosophical approach to bioethical problems. In their the necessary development of new technologies which can bring
professional activity, physicians will constantly face bioethical positive outcomes for patients’ health and safety and the need to
problems and have to make decisions requiring not only a stop developing old technologies that are money consuming and
profound medical knowledge, but also knowledge on ethics, law harmful to health.
and philosophy. Having said that, the importance of better considering ethical
There is a need to harmonize education programs on bioethics considerations while assessing health technologies must be
used in the CIS countries being, at the same time, UNESCO clearly underlined. The respect of the ethical standards should
member‐states. not halt the technological progress (like e‐health, m‐health,
Currently, none of the CIS countries has a system for training health databases/bio‐banks…). On the contrary, according to the
specialists of higher qualification (Candidates and Doctors of World Medical Association (WMA), ethics includes progress in a
sustainable and human perspective as masterly demonstrated in conditions and co‐morbidity. It offers better accessibility to

the WMA Declarations of Helsinki and Lisbon. Ethical standards medical advice for broad range of population. It empowers the
refer among other things to information/consent of the patients, patient in decision making for improved health outcomes.
independence of the physician, medical secrecy/ confidentiality The Center is manned by members of a multi‐disciplinary staff,
but also equal access to healthcare. The technological standards including nurses, physicians, social worker, nutritionist, and
should be adapted to the human beings. It is thanks to ethics clinical pharmacist, who use diverse technologies, including
than the technological progress can be applied to the medical telephone calls and video calls, to monitor clients. Simple, easy‐
level by ensuring the transition from technics to the human and to‐use, high‐quality video communications help solve many client
individual dimension. concerns involving accessibility and availability.
Moma works in collaboration with various factors in the
community services including primary and secondary physicians,
“DR.” WATSON: AI, ETHICS, AND THE FUTURE OF multi‐disciplinary team, at home care units, Maccabi nonstop call
MEDICINE center, emergency medicine services and primary clinics.
In diabetes team Moma center proved to be efficient in
Amy DeBaets improving A1C levels, HVA measurement and compliance in 1300
Kansas City University of Medicine and Biosciences, USA patients, whiten half a year. Moreover, it is interesting to find
adebaets@kcumb.edu that the improvement in glycemic control concept constant over

time ‐ that is, the group also released for other reasons do not
The development of the field of bioethics is intricately bound up
return to the values of HbA1c before the intervention.
with the advent of new medical technologies that hold both
Together with these impressive results, there is a need to
promise and peril for patients and healthcare workers. Emerging
examine the significance of this innovative style and its ethical
technologies continue to shape the landscape of healthcare, and
meanings on patient care. This work will present the processes
this presentation will analyze some current trends in the
that were mad in Maccabi HealthCare Services in order to
development of artificial intelligence and robotics technologies
prevent possible issues, and the way high ethical and
that affect healthcare providers, patients, delivery systems, and
professional tele‐treatment is saved.
capabilities.
As advanced bioinformatics allow for less reliance on provider
knowledge in healthcare decisions and assistive robots reduce

ISRAELI CODE OF ETHICS FOR PRACTITIONERS OF
the strain of healthcare jobs and provide companionship to
patients, the roles and responsibilities of healthcare providers OCCUPATIONAL HEALTH

can be expected to change substantively. Likewise, realtime Raz Dekel
monitoring of health status using wearable computers may PPO Meuhedet, Israel
provide options in preventative care that are not currently erazmus@gmail.com
realized.
Whether these new technologies serves to augment, replace, or The practitioners of occupational health face many ethical
supersede human healthcare workers remains to be seen, and challenges in performing their duties. Double loyalties, pressures
will likely be dependent upon a variety of policy choices and by involved parties and attempts to influence their decisions are
other developments in workforce education and healthcare commonplace. The Israeli national council of worker's health
financing. Such technologies may be used to either advance or appointed a committee representing many occupational health
inhibit the humanization of healthcare and the work of caring for professions for drafting a code of ethics for practitioners of
patients as whole people. In one scenario, AI and robotics occupational health. The code, integrating principles from
technologies may be used to simply replace human caregivers parallel national ethical codes and a few "local" principles was
and could leave patients increasingly isolated. On the other hand, ratified by the council and will be presented alongside the ethical
the same technologies could also be used to free human challenges it is meant to aid in solving.
caregivers from the physically challenging aspects of caregiving in
order to focus on the humane side of healthcare.
PAIN, CONSCIOUSNESS AND THE CEREBRAL CORTEX

MOMA CALL CENTER FOR MONITORING AND Marshall Devor
Hebrew University of Jerusalem, Israel
TREATMENT
marshlu@mail.huji.ac.il

Sara Dejavsarov, Angela Irony
The ability to suffer pain is a sentinel of conscious perception.
Maccabi Healthcare Services, Israel
Many ethical dilemmas vanish, or are at least diminished, if the
Dejav_s@mac.org.il
individual or non‐human organism involved feels no pain. It is
Population aging and the increased demands to care for complex generally presumed that consciousness, and by extension pain
chronic conditions press an economic stress on the healthcare perception, is a function of an intact cerebral cortex. For this
system. Thus, novel service solutions are needed assuring quality reason, in situations in which the cortex is absent or severely
care besides cost effectiveness. compromised it is generally presumed that pain perception, and
Maccabi Healthcare Services, in conjunction with the Gertner the ability to suffer, are absent. This widely accepted
Institute, has established an innovative call center for monitoring presumption has practical implications for ethical decisions
and treatment a range of chronic conditions. concerning lower animals in which there is no cortex, embryos
Moma's population involves around 7000 concurrent patients and fetuses in which the cortex is not yet mature, and adults who
suffering from a range of chronic conditions (CHF, COPD, DM‐II). have suffered severe cortical damage. In this presentation I will
Since it's opening in July 2012 Moma has served around 10,000 consider the evidence that pain perception is indeed seated in
patients. the cortex and necessarily absent when cortical function is
The novel technology call center presents a new approach to lacking. Based on available evidence from direct brain
management of large population with complex chronic stimulation, lesions, electrophysiological recording and non‐
invasive imaging I will argue that there is in fact considerable particulars of the individual case). Nonetheless this new
uncertainty about the reigning dogma that pain, and by approach, personal injury lawyers, insurers and judges lack
extension consciousness, require a functioning cerebral cortex. something like guidelines, that will assist courts and insurers in
the assessment and quantification of noneconomic damages.
This guidelines (especially by assessment of the loss of amenities)
WITHDRAWAL OF LIFE‐SUSTAINING TREATMENT: are based on the International Classification of Functioning,
A COMPARATIVE ANALYSIS OF MAINLAND CHINA, Disability and Health (WHO). The novelty of this idea can be seen
TAIWAN AND HONG KONG in a specific use of this classification (ICF). Usually is ICF used in
clinical settings for functional status assessment, goal setting &
Chunyan Ding treatment planning and monitoring, as well as outcome
City University of Hong Kong, Hong Kong measurement. Due to this primary goals of ICF looks Czech usage
chunding@cityu.edu.hk of this classification very uncommon and rather unsuitable. On
the other hand ‐ this might be the first attempt how to unify the
Withdrawal of a life‐sustaining treatment from an incompetent system of the assessment and quantification of noneconomic
patient at the end of his life is a complex issue involving social, damages in Europe on the basis of internationally accepted
ethical and legal concerns. Little has been known about how classification.
Chinese societies deal with the issue, let alone the comparison of
ethical and legal norms on the issue adopted by different Chinese
societies. To conduct a comparative analysis, this article selects
PROBLEM FORMATION OF THE ETHICAL REGULATORS OF
Mainland China, Taiwan and Hong Kong because they root in the
THE PHYSICIAN PROFESSIONAL ACTIVITIES
Chinese culture and share the traditional Chinese views on life
and death, but have not adopted the similar rules on withdrawal Alena Donika
of life‐sustaining treatment. This article aims to identify the Volgograd State Medical University, Russia
similarities and differences of the law and practice regarding addonika@yandex.ru
withdrawal of life‐sustaining treatment among these three
jurisdictions, and further explore the underlying reasons from Implementation of bioethical principles in medicine is impossible
social, ethical and legal aspects. without recognition of their absolute and meaningful use of a
professional group of doctors. In this context, we conducted a
study on the value orientations of doctors on the undergraduate
ETHICAL TREATMENT IN PSYCHIATRY stage to assess the formation of ethical regulators of the
professional activities of doctors. Conducted a comparative
Anthony Dinnen analysis of value motivations of doctors and medical students
Anthony Dinnen P/L, Australia revealed underdevelopment moral qualities of empathy
doc@dinnen.com.au considered undergraduate professional group on stage.

According to our data, only 46.3% of the surveyed medical
From Soranus of Ephesus 2000 years ago through Pinel 300 years
students have expressed an altruistic orientation and 37.3% of
ago to the emptying out of the asylums in our times Psychiatry
the study ‐ the selfish orientation (p> 0.05). At the same time,
has had to grapple with the ethics of treatment. The history of
similar studies on model groups of doctors have shown that the
Psychiatry, perhaps more than any other field of Medicine,
majority of physicians (69.2% of physicians and 83.3% of
reflects the moral dilemmas we face. Are increasing numbers of
surgeons) has altruistic orientation (p <0.05). Orientation
homeless with mental illness in our cities a reflection of “moral
selfishness marked by no more than 15.7% of physicians. The
treatment” or an abandonment of the physician’s duty to heal.
obtained results reflect the overall negative trend in the
We have to reconcile the madhouse of Bedlam and the myth of
orientation of the youth society and can be predictive of future
mental illness of Thomas Szasz with our duty of care as physicians
decline in the importance of ethical principles of medical
to our troubled patients. Do we act, as a leading psychiatrist in
practice.
Australia advised, according to what a roomful of our peers
would approve? To address these ethical challenges, current
treatment practices in Psychiatry, particularly with regard to the

CHALLENGES FOR WESTERN ETHICS IMPLEMENTED
treatment of Posttraumatic stress disorder, are discussed.
IN HEALTH CARE OF MULTI‐CULTURAL COMMUNITY –
AN AUSTRALIAN ETHICAL DILEMMA

PERSONAL INJURY COMPENSATION IN CZECH REPUBLIC Russell D’Souza
AND THE INTERNATIONAL CLASSIFICATION OF Australia
FUNCTIONING, DISABILITY AND HEALTH russell.f.dsouza@gmail.com

Tomáš Doležal Australia is a multicultural society yet its dominant ethical
Institute of State and Law of Academy of Sciences, Czech Republic paradigm is firmly placed in the western philosophical tradition.
tomas.dolezal@ilaw.cas.cz The fundamental concept that western ethics is based on, is that

of autonomy which implies that the individual is a free agent able
In January 2014 came in Czech Republic into force new civil code.
to make their own decisions. These are based on the individual’s
Traditionally was compensation for non‐economic damage claims
right to be informed about all treatment options. This
determined with the aid of tables. This tables prescribed overall
presentation will examine the ethical concepts of autonomy and
assessment of the claim on the basis of a basic point value and
truth telling. We argues that the western bioethical concepts of
the exact allocation of the points were the tasks of forensic
autonomy and truth telling in the practice domain may not be
medical experts. New civil code abolished this tables and
appropriate for different cultural groups. This can become a
currently there is no statutory basis for assessing bodily injury
source of ethical dilemmas and a challenge for western ethics.
claims with the aid of tables. The courts have to judge the cases
The presentation will conclude with an option for those working
based on equity (that means based on precedents and the
in multicultural societies suggesting the need to accommodate
differing cultural perspectives, while not comprising the ethical cases. Emphasis will be placed on differentiating these programs

principles. or missions from other forms of civilian or humanitarian aid.
While humanitarian or altruistic goals are often associated with
the work of civilian or NGO organization, and thus in line with the
THE STUDY AND ANALYSIS ON THE PRINCIPLE OF ethics of the medical profession, the strategic intent behind
INFORMED CONSENT IN THE FORENSIC IDENTIFICATION medical civilian assistance programs in the military presents
unique challenges representative of the problem of dual loyalty.
Lv Duan, Shu Bo‐Qing Huang, Zhi‐Min Su, Kai Liu,
Tao Wei, Zhen Li
Kunming Medical University, China EBOLA VIRUS AND INFECTIOUS DISEASE:
1132295138@qq.com THE DUTY OF PHYSICIAN TO CURE AND THE POSSIBLE

Objective: We try to understand the relevant realization, RISKS – THE HALACHIC DILEMMA

knowledge structure, attitude and behaviour, from those
Cesare Efrati 1, Nicole Piazza o Sed2, Claudio Cannaviello1
policeman and police woman who work in various public security 1
Jewish Hospital of Rome, Italy
bureaus (PSB) distributed in certain parts of Yunnan province in 2
Policlinic of Milan, Italy
people republic of China about medical ethics in forensic fields.
Cesare.efrati@gmail.com
We also try to find out the way to prove the knowledge, concepts
and behaviors about the forensic ethics. Is it possible for a doctor to endanger himself for treating a
Method: Making the enquiring forms by our investigator. Carry patient?
out the investigation work in Puer, Xishuangbanna and Yuxi The Rama writes that we do not find anywhere that we can
states, which distribute the southern part of Yunnan province. differentiate between infectious and non infectious disease with
The way of investigation is Self‐Administered Questionnaire regard to visit the sick, except for a particular illness of which the
Survey Method. The content of the survey includes the principles Gemara warns that one must not sit "in the shadow of the
of informed consent, principles of confidentiality, the principles patient".
of respect and the principles of justice and equality. However, Rav Chaim Palaggi writes that there is no obligation for
Result: (1)Among the informants, about 87% of them believed one to put oneself in danger to fulfil the mitzvah of “bikkur
that before performing the autopsy, there should be an informal cholim”.
consent taken about autopsy permit must be granted by the The Sefer Chassidim writes that a person with an infectious
relatives of the deceased ,and about 13% of them believe that skinhead disease should not bathe together with another unless
they do not have to get any informal consent, according to the he has told him of his disease, for the Torah says "you shall not
relevant provision(Criminal Procedure Law) (2)During the stand idly by while your fellow's blood is shed".
investigation ,we found out that those who believe that before Rav E.Y Waldenberg writes that a physician and anyone else
taking the human tissues for histological/toxicological whose duty it is to care for the sick, is permitted to endanger
examination the forensic police must get the permission, himself to do so and moreover, it is considered a great mitzvah
accounts for 91.3% of the crowd. on his part. He is not halachically bound to do so, but, on the
Conclusion: Although the forensic police have a higher other hand he must be certain that there is only a possible risk to
knowledge concepts and behaviors about the forensic ethics, but himself should he treat the patient.
sometimes it still needs to be proved and dealt with a certain Rav A.S Abraham asks why a doctor should not be obligated to
level of precaution to avoid any kind of postmortem conflicts treat such a patient who was in a life‐threatening situation. Since
between the two parties. the doctor, nurse, or any other caregiver entered their profession
on their own free will, knowing that there would be risk attached
to their job, surely they should be obligated to treat such a
THE INSTRUMENTALIZATION OF MEDICINE: seriously or possibly seriously ill patients also if there is a slight
THE PHYSICIAN‐SOLDIER & CIVILIAN MEDICAL CARE risk involved.

Sheena M. Eagan Chamberlin
University of Maryland University College, Germany VACCINATION OF HEALTH PROFESSIONALS
sechamberlin@me.com
Leonid Eidelman, Leah Wapner, Malke Borow
Military medicine involves more than the care of soldiers and Israeli Medical Association, Israel
their families. Another side of military medicine involves the care michelle@ima.org.il; abbey@ima.org.il
of civilians and the instrumentalization of medicine by the Armed
Forces. In the U.S. military, civilian medical care has been used as Although vaccination has been proved to be a safe and cost‐
a strategic tool since the Vietnam War. This use includes effective intervention, immunisation rates remain suboptimal in
programs such as Medical Civic Action Programs (MEDCAPs) and many countries, resulting in poor control of numerous vaccine‐
Medical Readiness Training Exercises (MEDRETEs), which have preventable diseases.
expanded in scale and scope since their initial inception. Recently Influenza alone accounts for between 250,000‐500,000 annual
other national militaries have begun to employ these models of deaths globally and 3.5 million cases of severe illness. Between
civilian medical care (provided by the military). Unfortunately, 11‐59% of healthcare workers get the virus while caring for
these programs represent a uniquely complicated moral infected patients. In spite of this, health professionals also have
experience for the military physician. As a result physicians have low vaccine coverage. Influenza vaccination of health care
faced ethical dilemmas, moral distress and sometimes even workers is recommended by various health authorities
refused to participate. worldwide in order to prevent influenza, reduce staff
This presentation will explore and analyze these programs, absenteeism and protect vulnerable patient populations from the
focusing on the physician experience, and the realities of increased morbidity and mortality that influenza carries.
participation. Examples will be drawn from the US military Mandatory vaccination of health care workers has been
experience in the past, as well as contemporary international implemented in some settings. For example, a number of
healthcare facilities require immunity to infections such as emails, sales of George Orwell’s 1984 were up by 7,000%. For
measles, rubella, mumps and tuberculosis, as a condition of years, journalists and academic experts have been raising
employment. Nevertheless such policies have raised considerable concerns about what they call “Big Brother” in medical
controversy and ethical questions among them issues of personal surveillance and monitoring. As early as 2000, referring to then‐
autonomy versus professional responsibility and whether there new techniques to monitor patients’ medical adherence, Cynthia
exists sufficient scientific basis to justify mandatory vaccination Rand and Mary Ann Sevick have warned, “We are on the
of health care workers. threshold of having an armamentarium of ‘big brother’ strategies
The presentation will provide a background to different campaigns to determine who is noncompliant.” Other writers use “Big
targeting medical professionals and discuss the ethical implications Brother” for a cluster of more recent and technologically‐
of mandatory vaccination of healthcare professionals. advanced interventions for closer surveillance of patient
behaviour and patient outcomes.
Let us set aside worries about Big Brother fears and their cogency
HOW TIGHTLY ARE PAIN MEDICINE AND MORAL outside medicine. How cogent are those fears within medicine?
STANDARDS RELATED TO EACH OTHER? We argue, not very much.
We focus on the case of Electronic Adherence Monitors (EAMs),
Elon Eisenberg especially in the Ugandan setting in which we use them. EAMs
Rambam Health Care Campus and Technion – Israel Institute of record and report an array of health behaviors, ranging from
Technology, Israel taking daily medication to wearing medical devices. These
e_eisenberg@rambam.health.gov.il devices are used in studies around the world, and are being

considered for use by clinicians. They have become a key tool for
Although the obligation to alleviate pain and suffering has been
studying health behaviors. However, use of EAMs is increasingly
the core of medicine since ancient times, pain medicine, as an
alleged in the media to represent a move towards “Big Brother”
independent profession, is only at its infancy. Nonetheless, pain
in medicine. We highlight the unique benefits as well as the
medicine is already challenged by significant ethical dilemmas,
potential ethical challenges that electronic monitoring generates.
some of which to an extent which may question the future of
Potential philosophical and practical solutions to many of these
pain medicine as an independent medical profession.
challenges are presented.
First, due to historical and conservative notions, major
deficiencies in pain education occur in medical schools
worldwide. Consequently, care givers who lack proper skills to

MALPRACTICE, PERSONAL DAMAGE AND
diagnose and treat pain, often ignore their basic moral obligation
by opting not to treat pain. The rising number of reports and MEDICAL LIABILITY

warnings regarding adverse effects of commonly used pain S. Davide Ferrara
treatments, such as opioids and anti‐inflammatory drugs, some University of Padova; International Academy of Legal Medicine,
of which life threatening, fuel this tendency. Notably, law suits Italy
have already been filed against caregivers in the United States santodavide.ferrara@unipd.it
who failed to adequately treat cancer pain.
Second, private‐ and more recently public‐medicine has been The Hippocratic Oath of the Third Millennium founded the ethical
pushed to adopt economical or 'business oriented' models of role of the physician in relation to his professionalism and the
health care. As such, revenue generation treatments, invasive capacity to reduce the uncertainty in science, improving the
procedures in the case of pain medicine, have increased quality of the health system. With the adoption of the “Oviedo
dramatically whereas other less lucrative treatments (i.e. multi‐ Convention” in 1997, the principle that a “patient has a
disciplinary pain management programs) fail to thrive even if fundamental right to obtain compensation for unjustified damage
shown to be more effective than other treatments for chronic pain. (harm) suffered as a result of a medical intervention” was
Judgment of treatments according to income rather than outcome established, furthermore calling for an “intervention in the
creates a second, critical ethical dilemma in pain medicine. healthcare sector”. Despite these auspices, there has not been
Lastly, the amazing increase in use of medical marihuana for pain in any normative action intended to harmonize the regulations
Israel creates another moral dilemma. Encouraged by medical regarding medical professional liability and personal damage
authorities, prosecuted by the media when fail to comply, and estimation in Europe; while the multi‐fragmentation of each
demanded by patients, caregivers often feel forced to prescribe discipline is exhausted in the endless comparison between
medical marihuana, even when evidence of efficacy and safety (for “reason and fact”, which belong to the current global society of
both individual patients and for the society) are minimal at best. risk.
These dilemmas will be presented and discussed during the This is not only a matter of health laws, but an issue involving
presentation. medical ethics balancing opposite requirements: the health costs
due to “defensive” medicine, lack of physicians for more exposed
specialties and high transaction costs on one hand; the need to
DEFENDING “BIG BROTHER MD”: THE ETHICS OF promote civil justice, deter substandard care, identify
ELECTRONIC ADHERENCE MONITORING IN UGANDA incompetent practitioners, and encourage systemic quality
improvement on the other.
Nir Eyal1, Jeff Campbell1, Jessica Haberer2, Angella Musiimenta3, The International Medicolegal Academic Community has
Dan Wikler4 commenced the virtuous course of action and the difficult task of
1
Harvard Medical School, USA contending with Medical Malpractice and Personal damage
2
Massachusetts General Hospital, USA estimation, a real pandemic. Two International Interdisciplinary
3
Mbarara University of Science & Technology, Uganda Guidelines where produced on these issues, and here presented
4
Harvard School of Public Health, USA to answer the unsettled demand for the harmonization of
Nir_eyal@hms.harvard.edu ascertainment methodology and evaluation criteriology on such

topics, with so many direct and/or indirect ethical implications.
Within a week of Edward Snowden’s revelations that America’s
NSA monitors citizens’ Facebook accounts, Google searches, and
TO WHAT EXTENT DOES A SURROGATE HAVE REAL school vaccination programs in the US and Israel against the
AUTONOMY? human papilloma virus (HPV) will be used as a case study.

Julia Feuer
Bar Ilan University, Interdisciplinary Center (IDC) in Herzliya, Israel RIPPLE EFFECT OF SIMULATION TRAINING FOR
Jfeuer@013.net.il END‐OF‐LIFE CARE

In contemporary society, the concept of autonomy is discussed Meir Frankel1,2, Yael Lahat2, Adir Shaulov3, Matan J. Cohen3,
as a norm. This may be true in a western democratic society but 3 3 4
Ran Eliaz , Charles L. Sprung , Alan Rubinow ,
may not occur on a global basis. This paper will explore whether 2 2 5,6
Henia Perry‐Mezare , Rina Yahalom , Amitai Ziv , Mayer Brezis
3
surrogates in cross border surrogacy arrangements really have 1
Meir Medical Center, Israel
autonomy. Surrogacy can only be undertaken by women; 2
Clalit Health Services, Israel
therefore this subject should be explored from a feminist 3
Hadassah – Hebrew University Medical Center, Israel
perspective taking into account the theories of ethics of care and 4
Ministry of Health, Israel
relational autonomy. 5
MSR – Israel Center for Medical Simulation, Israel
Cross border surrogacy is a growing industry, but the area is 6
Sheba Medical Center & Tel Aviv University, Israel
often unregulated or without sufficient safeguards to protect the frankelm@gmail.com
needs of the surrogate during the whole process. There are many
legal, cultural and circumstantial differences between surrogates Improving quality of end‐of‐life (EOL) care demands a paradigm
in this global phenomenon. Not all women are able to exercise shift in attitudes of healthcare providers and patients to discuss
their rights and many are led to surrogacy from a situation of and respect care preferences at EOL. Coping with uncertainty
poverty. To some surrogacy may lead to empowerment and to requires capacity for paradoxical thinking and for bioethical
others abuse. discourse. Institutions need to develop preparedness to EOL with
It can be concluded that the concept of relative autonomy is palliative care, appropriate resources and executive policy.
different according to the circumstances of the surrogate and her In 2011, we initiated a 1‐day simulation‐based training workshop
location. In many ways she is exercising her autonomy, taking to improve EOL skills with professional actors, personal feedback
into account the needs of her family, but if circumstances were and video‐based debriefing discussions. In 3 years, over 350
different contractual surrogacy may not be her choice. Protective residents, senior physicians and nurses from 21 hospitals and 3
legislative measures and full informed consent should become nursing homes attended the workshop, which was conducted at
standard procedures, so that she can be safeguarded and be able MSR – Israel Center for Medical Simulation. Surveys and focus
to influence the medical procedures and the conditions to which groups up to one year later indicated high satisfaction with
she is subject in order to achieve real autonomy. workshops, improved knowledge, attitudes, skills and practice.
Group discussions at workshops portrayed a rich picture of field
challenges and triggered a series of “bottom‐up” initiatives.
HOW NOT TO RUN A VACCINE PROGRAM: Collaboration with Clalit Health Services, Ministry of Health
ETHICAL ISSUES AND TRANSPARENCY (MOH), and Israeli medical associations of Internal Medicine,
Geriatrics and Intensive care, secured systematic training of
Diana Flescher workforce in medicine and geriatrics, later extended and adapted
Israel to intensive care units and other specialties.
flescher@012.net.il Workshop participants were involved in the delivery of lectures

on EOL to healthcare executives and the general public as well as
National vaccination programs purport to serve the public good
in local initiatives such as seminars, research projects (e.g. –
by preventing disease morbidity and mortality, absenteeism from
survey of nursing homes), publications and the establishment of
work and school and chronic disability. However, in the
a palliative care unit. All the above was presented to the MOH,
developed world the public has been increasingly expressing
which initiated a national evaluation of preparedness to EOL and
"vaccine hesitancy" i.e. questioning the benefits of vaccination
nominated a committee for reforming regulation.
and alarmed by possible risks. Public mistrust of reassurances by
In conclusion, simulation training appears to trigger multi‐level
government bodies has led many parents and individuals to
effects to improve EOL care in Israel.
refuse or delay vaccination.
The benefit of a particular vaccine must outweigh the risks of
vaccination, especially since vaccination targets healthy

“EU”, SHORT FORM FOR “ETHICAL” UNION?
individuals, who may never come in contact with the offending
virus. A national vaccination program must therefore adhere to THE ROLE OF ETHICS IN EUROPEAN UNION LAW

at least three tenets: 1) the disease must be clearly linked to the Markus Frischhut
targeted virus, in the absence of confounding cofactors 2) the MCI Management Center Innsbruck, Austria
lethality of the virus must be clearly documented and accepted in markus.frischhut@mci.edu
the public perception and 3) the incidence of serious adverse
events caused by the vaccine must be acceptably low, i.e. lower Background: In various legal (binding and non‐binding)
than the morbidity in an unvaccinated population. This last is the documents, the European Union (EU) refers to the concept of
most challenging in a widely vaccinated and healthy population “ethics” (and/or “morality”), without providing a definition or at
with no communal memory of diseases prevalent in the least indicating a certain understanding. However, if a certain
prevaccination era. activity is qualified as “unethical”, there can be important
This presentation will review the issues and actions leading to consequences, such as exclusion from funding under the
public mistrust and will delineate the standards necessary for “Horizon 2020” program, or no right to cross‐border healthcare
ethical vaccination programs, involving greater transparency in under the “EU Patient Mobility Directive”, just to name a few
preclinical trials and post‐marketing studies and improvement in examples.
reporting systems. In this way, governments can allay public fears Method: In this research, the author reviewed both EU Primary
and prevent the reemergence of devastating diseases. The recent (TEU, TFEU), and especially EU Secondary law. In the latter
category, approx. 60 relevant documents have been identified, THE STUDY OF THE NATIONAL CUSTOMS IN FORENSIC

where the term “ethics” (etc.) has been used. A special emphasis IDENTIFICATION
has been put on bioethics, although also other sectors have been
involved in this study, in order to draw a more holistic picture. Sheng Gao1, Ke‐Ran Li 1, Wen Wu‐Bei Chen1, Hong Liang2,
Results: I will argue that in a lot of cases (especially EU Primary Zhen Li1, Tao Wei1
1
law), ethics is (only) used in order to avoid interference of the EU Kunming Medical University, China
2
in Member States competences, especially in sensitive fields, like People's Procuratorate of Kunming, China
abortion. However, in EU Secondary law there are also positive JasonLi7@163.com

approaches of increasing clarity. This is done by Ethics
Objective: Involved in the forensic identification of the police in
Committees and/or Code of conducts, in both cases either at EU
Yunnan Province, ethnic customs issues are conducted
or at national level. In some examples, there are even some hints
investigates, providing guidance for forensic medicine appraisal
or references to other sources, or to the national level, in order
work.
to determine the relevant content. Still, there are also
Method: Using cluster sampling method to carry on the
documents without any determination as regard the content.
questionnaire survey to the police in some areas of Yunnan
I will further argue that those gaps mainly have to be filled at EU
Province behavior in his work, the investigation time for one
level with reference to the EU fundamental rights, especially the
year.
“key stone” of human dignity, the right to life and the right to
Results: We will divide the respect for the national customs into
integrity (Articles 1‐3 of the EU Charter).
three levels, including great importance, importance and
unimportance, people thinking of great importance to the
respect for the national customs account for 71.09%, people
EAST AND WEST BIOETHICS – MORE SIMILARITIES AND
thinking of importance to the respect for the national customs
GOOD FOR GREATER HUMANITY account for 28.99%, people thinking of importance to the respect

Harischandra Gambheera for the national customs account for 0%. In the investigate of
Sri Lanka disagreement to do a postmortem because of the special of
hgambheera@gmail.com National customs, people agreeing to give up do a postmortem
account for 11.59%, agreeing to force to do a postmortem
We consider two major cultures in the world, east and west. The account for 4.35%, agreeing to do a postmortem after working
ethical values derived from Hippocratic Oath and developed in on them account for 84.06%, people thinking that Case need to
the west was considered western tradition. Similarly in the be more cautious in minority nationality areas account for
eastern culture, ethical guidelines for doctors (healers) have 76.09%.
been laid down in the oath of Initiation for physician by Acharya Conclusions: Involved in the process of forensic identification of
Charak in his renowned work “Charak Samhita” which is ethnic customs problem is of great significance to Forensic
considered as encyclopaedia of Ayurveda. Even though we medicine appraisal work, and all of the forensic workers should
observe minor variance those could be justified considering strengthen forensic ethics study. Meanwhile, in the actual daily
cultural differences in these two major cultures, there are large work, forensic workers should adequately combine national
similarities accounted for greater humanity. In fact there are customs problem, the rights and obligations of forensic expert
more similarities than difference in these two traditions of ethics witnesses and identified person and Code of ethics in the forensic
in medical practice. This presentation will elucidate the ethical medicine appraisal.
traditions in East and West, then attempt to consider the
similarities and differences including the cultural differences
FORCE‐FEEDING HUNGER STRIKERS:
HUMANE OR INHUMANE TREATMENT?
EMPHASIS ON SOCIO CULTURAL DIVERSITY IN TEACHING
BIOETHICS IN MEDICAL Mirko D. Garasic
Tel Aviv University, Israel
Barna Ganguly mdgarasic@fulbrightmail.org
India
barnaganguly@rediffmail.com In the USA, Israel and other countries there has been a wave of
Hunger Strikes (HS) in recent years. In line with the nature of this
Medical profession is confronted by an explosion of technology, panel, in this paper I will take into account two recent articles
globalisation. The medical professional everywhere is embedded that discussed the moral implications for doctors involved in
in diverse cultures natural traditions. There are wide variations in situations of HS –particularly in relation to Guantanamo’s
medical delivery and practice. As a result the physicians find it prisoners. The authors of these articles, Annas et al. and Gross,
difficult to meet the responsibilities to patients and society. call on physicians to refrain from force‐feeding (FF) inmates for
There is now increased concern about the knowledge of socio‐ two reasons: 1) FF is a direct violation of one’s autonomy, and
cultural diversity for the medical professionals both in practice complicity of physicians in the act implies violation of medical
and research. Responding to this challenges, one of the ways to ethics, and 2) if physicians indeed stop FF, the conditions of at
avoid the difficulties is to recognize and emphasize on least some prisoners will improve. I will provide a few additional
sociocultural diversity while teaching Bioethics in undergraduate considerations concerning the issues at stake that are worth of
medical curriculum. attention. In what follows, I will first briefly review these papers
and the ethical dilemmas raised by them. Second, I will enlarge
the analysis of HS at a global level, showing that its detachment
from politics is impossible.

GLOBAL BIOETHICS AND THE CHALLENGE OF LAW, BIOETHICS AND MEDICAL DECISION‐MAKING:
CONVERGENCE IN CULTURAL AND RELIGIOUS DIVERSITY THE IMPACT OF CULTURE

Alberto Garcia Roy Gilbar1, Jose Miola2
1
UNESCO Chair in Bioethics and Human Rights, Italy Netanya Academic College, Israel
2
agarcia@unescobiochair.org University of Leicester, UK
roygilba@gmail.com
In contemporary bioethics some secular scholars and politicians
claim that global bioethics should ignore religious convictions Western medical law and bioethics have developed in a way that
since religion, through history, has been cause of conflicts, wars has promoted a liberal‐individualistic approach to patient
and misunderstanding. Religions are so different that dialogue autonomy. These two areas have also perceived the patient
and common ground in bioethics is useless and fruitless since alone as the unit of care and focused on the personal rights of
believers are biased by their religious convictions. the patient. In light of this approach, it has been less clear how
We claim that in a multicultural and multireligious world, to Western medical law and bioethics address the cultural values of
foster convergence and cooperation in global ethics is not only patients from non‐Western backgrounds who believe that “you
possible but it is a moral and political demand entailing to assure are your family and your family is you”, and prefer, inter alia,
effective and democratic participation of the different cultures in hope to full disclosure and family‐determination to self‐
bioethical debates. Academic institutions might develop and determination.
important role in this endeavor. This paper will examine whether and how medical law and
A global bioethics ignoring religious beliefs would cause that bioethics deal with the desire of patients from non‐Western
“universal” principles and guidelines established by international backgrounds to follow their cultural values, to remain passive in
organizations be challenged as illegitimate or unjust, being decision‐making and to provide their family the decision‐making
rejected or disobeyed, invoking freedom of conscience. Its authority. This paper will argue that this desire is not catered for
Conventions or Declarations, even though formally supported by effectively either in English and Israeli medical law or by the
State representatives, would be essentially antidemocratic. professional ethical guidelines published by the British General
Those claiming that bioethics should be rooted in a particular Medical Council and by the Israeli Medical Association.
religion and that “only their God” or “tradition” is the only source The paper will examine an alternative approach based on
of moral behavior would deny freedom of conscience and relational autonomy that might serve both to allow such patients
religion of others believers as well of non believers. They should to follow their personal preferences while still allowing them to
learn from moderate positions within their own religious include family members in the decision‐making process. The
traditions and respect reasonable secular approach. paper will offer some legal solutions in this context.
An spirit of dialogue and mutual understanding should help to
foster the art of convergence and cooperation in bioethics.
Theological reflection might help to understand, through faith, PRINCIPLES OF PSYCHOLOGICAL ASSESSMENT OF
ultimate sense and foundation of life and moral behavior PARENTAL COMPETENCE IN THE MUSLIM‐ARAB SOCIETY
according to different religious beliefs, but only science and IN ISRAEL
reason should illuminate bioethical debate in a globalized world.
Human dignity and human rights/duty language might be helpful Emad Gith
to facilitate this understanding in global ethics. International Center for Health, Law and Ethics, University of
Haifa, Israel
emadgith@gmail.com

SUICIDE PREVENTION IN EMOTIONAL FIRST‐AID
According to Sharia law, a son remains under his mother's care
SERVICES: ETHICAL DILEMMAS

until he reaches age 7 and a daughter remains in her mother's
Itzhak Gilat care until age 9. Once they reach these ages, the father is
The Israeli Association for Emotional First Aid (ERAN), Israel granted custody of the children. If there is no father, custody is
gilati@netvision.net.il granted to their grandfather. Muslim‐Arab citizens in Israel
consider the Sharia court the legal authority certified to
Services of emotional first aid provided by trained volunteers are deliberate and rule on laws pertaining to divorce, custody,
viewed as valuable source of crisis intervention and suicide adoption and guardianship.
prevention for more than five decades. From their very In case of disagreements between parents regarding custody of
beginning, these services faced ethical dilemmas regarding their children, the Sharia court or the family court determines
interactions with callers who expressed explicit wish to die or who shall be granted custody. In order to do so, it requests
threatened to commit suicide. The dilemmas emerged from two psychological assessment of parental competence. It should be
conflicting ethical guidelines: Respecting the anonymity of callers noted that professionals often encounter various professional
to these services (which is a major principle in the ethical code) and ethical issues in the Muslim‐Arab society as the assessment
on the one hand and saving lives of individuals at risk, which is highly culture‐dependent. Muslim society is a collective one, in
sometimes requires to violate the anonymity, on the other. We which the extended family plays a very dominant role and men
shall present in detail and exemplify the nature of this dilemma are considered to have higher standing than women.
within the context of the Israeli Association for Emotional First When psychological assessment is required, it is conducted
Aid (ERAN), that offers assistance via telephone and internet. according to diagnostic data and accepted diagnostic tools.
Today, there are no psychological assessment tests that have
been adjusted for the Arab population. A test must be reliable
and reflect the circumstances being evaluated and the lack of
standardization for many of the existing tests makes the
assessment process irrelevant. In certain cases, initial counter‐
examination puts the professional in an uncomfortable situation.
This is true for the Arab world as well. It is clear to almost all
psychologists that they must use their own professional training also increasingly concerned that the H2N2 strain of influenza
and experience after conducting the assessment in order to make could threaten another pandemic.
a diagnosis that accurately reflects the patient's inner‐emotional However, the question of compulsory vaccination raises a
or cognitive reality. number of important questions which go to the heart of medical
As a result, the existing general model for assessment of parental law and ethics: how far should government act in order to
competence in Israeli society cannot be applied as it is culture‐ promote or protect the public good? Is it legitimate to constrain
dependent, and does not reflect the culture of the Muslim‐Arab individual interests/rights in autonomy, liberty, privacy or
minority in Israel. Therefore, I believe that there is a need to property in trying to protect collective interests in health?
develop a model that is suited to the emotional‐culture world in Compulsory vaccination is often regarded as an unwarranted
question. The new model should take into account the Sharia government interference with autonomy and liberty, but to what
legal system and the impact of the extended family on the extent does this present an irreconcilable tension? Does the
individual, and emphasize the differences between men and potential benefit of herd immunity trump all other individual
women in Arab society. Most importantly, the model should interests? Should a compulsory vaccination programme be
reflect sensitivity to the patient's cultural world. A model of this undertaken as part of an overarching civic duty to the collective?
kind will, of course, serve as a complimentary tool to existing The responsibilities for our own health and that of others are
diagnostic tools that are commonly used today for this purpose. interactional in nature. Arguably, this is brought starkly into focus
in the vaccination context when it is considered that in tax based,
national health care systems, such as the NHS, increasingly it is
FORCE‐FEEDING HUNGER‐STRIKING PRISONERS – recognised that not all responsibilities for good health can fall
ANOTHER VIEW upon the system and none on the users of the system.

Shimon M. Glick
Ben Gurion University of the Negev, Israel RITES AND RITUALS OF DYING:
gshimon@bgu.ac.il A SHIFT TO MEDICAL TECHNOLOGY

During the past few decades many Western medical Michael Gordon
organizations including the Israel Medical Association have Baycrest Geriatric Centre and University of Toronto, Canada
forbidden physicians to feed hunger‐striking prisoners without m.gordon@baycrest.org
their consent as a violation of human rights and as torture.
I contend that in line with decisions by Israeli courts and in line The shifting world of medical technology has had a profound
with Jewish culture the right to life should take precedence over impact on the way individuals view the dying process. The
that of human dignity in these cases. process of dying was accompanied by rites and rituals of dying,
In the face of such hunger‐strikers there are three alternatives‐ drawn from religious, cultural, ethnic and community/family
Permit them to fast until permanent disability or death – this traditions. Prayers, chants, songs and human communication and
causes more suffering than passing a nasogastric tube; physical and emotional touch, prepared the loved one to leave
acquiescing to the prisoners' demands, which makes hunger the world and those left behind to be part of the transition from
striking the ultimate weapon of prisoners, leading to anarchy; or life to death. The rapid growth of medical technologies has
imposing feeding of the prisoners against their will, which I shifted the focus from traditional rites and rituals to a
contend is far more humane and reasonable. replacement with medical technologies the most dramatic of
Hundreds of hunger strikers have been permitted to die in Great which include “salvage” therapies such as CPR, potent antibiotics
Britain, South Africa and Turkey, which in my opinion does for what are often terminal or pre‐terminal infections,
reflects shame on those societies. chemotherapies for advanced malignancies and a range of
Many hunger‐strikers after being force‐fed express gratitude that medical and surgical interventions that meet the needs of the
their lives have been spared, since almost all of them did not families as much as or more than the clinical benefit of the
wish to die. Almost all prisons go to great lengths to prevent patients. During the grieving period one often hears families laud
suicide by prisoners; it should similarly make it clear to hunger‐ the attempts to postpone death through medical technologies.
striking prisoners that while they will be permitted to fast, if and Commonly heard phrases include: “the most powerful antibiotics
when a serious danger develops to their health and life an end were used in an attempt to save him”; “they did not give up the
will be put to the fast. resuscitation until he was too far gone to continue” or most
This approach is in keeping with the Jewish tradition of important, “we did our best to save him”. The recognition of the
incommensurability of human life and with a communitarian quasi‐ritualistic role of end‐ of‐ life medical technologies must be
rather than an individualistic ethic. included in how we communicate with family members who
focus on such treatments rather than comfort and quality at the
end of life.
COMPULSORY VACCINATION AND THE COLLECTIVE
GOOD: GOING BEYOND A CIVIC DUTY?
THE ETHICAL ROADBLOCKS TO MEDICAL TOURISM
Nicola Glover‐Thomas
University of Manchester, UK Elinor Goshen, Baruch Chen, Tami Karni
nicola.glover‐thomas@manchester.ac.uk Israeli Medical Association, Israel
michelle@ima.org.il; Karen@ima.org.il
Distrust of vaccines, from the pertussis vaccine controversy in
Great Britain in the 1970s and 1980s through to the MMR study Medical tourism has noticeably increased over the years due to
in 1998, has threatened efforts to protect patients from the ease and diminishing costs of travel, increasing healthcare
preventable diseases. Latterly, this distrust has evinced further costs, and globalization. In tandem with this, increasingly
difficulties in responding to more recent threats presented by the aggressive marketing campaigns, in some countries hospitals and
H1N1 and seasonal influenza viruses; public health officials are insurance companies have begun to leverage their connections
to grow the medical tourism business into a major economic ENTERAL NUTRITION IN END OF LIFE:
force. This raises several ethical questions. THE JEWISH HALACHIC ETHIC
The rise of medical tourism emphasises the privatisation of
health care, uneven access to health resources and the ever‐ Chaya Greenberger
increasing globalisation of both health care and tourism. Israel
However, empirical evidence regarding the health and safety greenber@jct.ac.il

risks facing medical tourists is limited. While individual patient
Providing versus foregoing enteral nutrition is a central issue in
risks may be offset by credentialing and sophistication in (some)
end of life care, affecting patients, families, and health
destination countries, lack of benefits to poorer citizens in
professionals. This presentation examines the Jewish approach to
developing countries offering medical tourism remains a generic
nourishing the dying in the context of other ethical perspectives
equity issue.
and analyzes their implications for practice.
The effect of medical tourism on the host country's population,
Jewish ethics is based on religious law, called Halacha. Many
particularly the poor, to be pushed farther down the queue to
halachic scholars perceive withholding nourishment even
receive care is also a cause for concern. In many countries,
enterally, as hastening death in principle. This reflects the divide
resources are used to build up their foreign trade instead of
they perceive between allowing a fatal disease to naturally run its
developing the local healthcare system. Another potential
course until an individual's vitality (life force or viability) is lost,
problem is the obligation of the home‐country physician to
versus withholding nourishment for the vitality that still remains.
provide follow‐up care.
The latter they maintain, introduces a new cause of death.
There are a myriad of problems and ethical questions associated
Nevertheless, coercing an individual to accept enteral
with this area, including quality of care, adequate
nourishment is generally considered undignified and
documentation, doctor‐patient relationship, and complete
counterproductive.
patient information. There is also the issue of promotion of
A minority of halachic scholars classify withholding enteral
medical tourism. This presentation will explore the current
nutrition as refraining from prolonging life, permitted in principle
situation of medical tourism in Israel and address these issues.
under certain circumstances, especially in situations where
nutritional problems flow directly from a fatal pathology.
In the event of enteral nourishment becoming a source of
ETHICAL, LEGAL AND SOCIAL IMPLICATIONS OF NEW AND
overwhelming discomfort, two halachic ethical mandates would
EMERGING TECHNOLOGIES: EXOSKELETONS come into conflict: sustaining life by providing nourishment and

Dov Greenbaum alleviating suffering. As in all moral conflicts, these would have to
Radzyner Law School, Israel; Interdisciplinary Center (IDC), Israel; be resolved in practice.
Yale University School of Medicine, USA In the very final stages of dying there is a general consensus that
Dov.greenbaum@idc.ac.il, dov.greenbaum@yale.edu enteral nourishment may be withheld, providing that this reflects
the dying individuals' wishes.
Science fiction has become reality: FDA approved exoskeletons In a world that remains broadly religious, it is necessary for
are now available to help disabled patients gain back lost health professionals to broaden their understanding of religious
mobility. Succinctly, exoskeletons are mechanical appendages perspectives on ethical issues and how they compare to those of
that allow paraplegics the ability to stand and walk. While this a secular nature.
incredible technology has the potential to help tens of
thousands, it raises new and interesting ethical, legal and social
issues that ought to be dealt with before the technology PRE‐IMPLANTATION GENETIC DIAGNOSIS FOR SEX
becomes entrenched. SELECTION FOR NON‐MEDICAL REASONS:
These concerns include the development of the technology for POSITION STATEMENT OF THE ETHICS COMMITTEE OF
military use, particularly, when that use dehumanizes soldiers
THE ISRAEL FERTILITY SOCIETY
and makes them more likely to kill or be killed. Dual uses also
exist for high‐strain, repetitive work environments where Ronit Haimov‐Kochman1, Shlomo Mashiah2, David Heyd3,
4 1 5
exoskeletons developed for the disabled could be co‐opted Aviad Hcohen , Einat Eisenman , Shlomo Vilk, Zvia Mimoni ,
6 1
(some might argued abused) for the able bodied worker. Etti Peretz, Hedva Eyal , Neri Laufer
1
Similarly, the ability of this technology to allow formerly Hadassah Hebrew University Medical Center, Israel
2
wheelchair bound individuals to walk skews the line between Tel Aviv University, Israel
3
abled and disabled. Hebrew University, Israel
4
The high cost of this technology raises social justice concerns Shaarei Mishpat School of Law, Israel
5
relating to fair access, and the use of these potentially always‐on Shaarei Zedek Hebrew University Medical Center, Israel
6
mechanical attachments raises issues related to human Haifa University, Israel
enhancement. These concerns will become more apparent when kochman@hadassah.org.il
direct neurological links to an exoskeleton further confuses the
boundaries between human and cyborg. Sex selection with in‐vitro fertilization (IVF) and pre‐implantation
Legally, there are issues associated with the regulation of these genetic diagnosis (PGD) is permitted in Israel only after the birth
devices, how different are they from motorized wheelchairs? of four children of one gender and following approval by the
Further regulatory controls may be necessary to prevent hacking national committee that was appointed to deliberate such cases.
the systems to further enhance and possibly unintentionally The committee was formed to prohibit sex determination except
harm a patient. Additionally, there are legal concerns related to in exceptional cases.
liability, particularly as eventual iterations of these exoskeletons The Ethics Committee of the Israel Fertility Society considered
become semi‐autonomous or even fully autonomous. diverse aspects of this issue but failed to reach a consensus
whether sex selection for non‐medical reasons should be
permitted at all.
The majority opinion asserts that sex selection is not necessarily
motivated by sexism, nor does it bear grave societal
consequences. The advances in IVF and PGD change the PRIMUM NON NOCERE V. CAVEAT EMPTOR
prohibition of sex selection from a theoretical debate to a
regulation limiting free choice and individual autonomy. Denial of Ross Halpin
the option to determine sex before implantation may even lead Sydney University, Australia
to the deplorable decision to terminate a pregnancy to prevent rwhalpin@gmail.com

the birth of a child of the unwanted gender. These assertions
The barbaric actions of Nazi doctors in medical research during
support the change of across‐the‐board prohibition of pre‐
the Holocaust were the genesis of the Nuremberg Medical Code
implantation sex selection to a policy of allowing it under specific
of Ethics. It was expected this code and similar codes established
limitations.
internally by the research institutes, would be recognized,
The minority opinion contends that the reasons for sex selection
applied and respected by all medical scientists and all institutes
often reflect prejudicial attitudes and stereotypical opinions;
involved in medical research. Similarly the Hippocratic Oath has
therefore, permitting pre‐implantation sex selection would be
been a powerful guiding light for doctors and physicians.
counter to principles of human rights, which are based on the
However based on evidence from what has and is occurring in
presupposition of gender equality. Based on the profile of
medical research, marketing of pharmaceutical products and the
applications to the committee in Israel, a clear preference for
relationship between the medical fraternity and pharmaceutical
males exists, creating a real risk to the welfare of the family and
companies the question must be asked if medical ethics is being
society. Prohibition of pre‐implantation sex selection sends a
undermined or in some cases abandoned.
clear message to society that preference of one sex over the
In this presentation I will discuss two issues:
other is morally unacceptable.
First: the results of a survey of a number of doctors, medical
The committee supported the provision of IVF‐PGD for sex
researchers, scientists and philosophers who were presented
selection under these limitations:
with human experiments carried out by SS doctors. The
1. In a patient undergoing IVF (with or without PGD) for medical
respondents were then asked questions related to the use of the
reasons.
data.
2. Only in families with three or more children of the same
Second: during the latter part of the 20th century and into the
gender.
21st century a number of the largest pharmaceutical companies
3. In any case the cost will not be covered by the national health
in the world have been made to pay multi billion dollar fines for
insurance.
selling off label drugs. This practice has resulted in the death of a
number of people.
Ironically on the one hand there is a link between the two issues
ETHICAL DILEMMAS AND MORAL DUTIES OF A that questions the place of ethics in medical research and
HOSPITAL DIRECTOR medical practice. The link is the question of life and death.

On the other hand ethics is being eroded because of the
Jonathan Halevy
influence of shareholders, profit and greed.
Shaare Zedek Medical Center, Israel
What needs to take place to maintain high ethical standards and
halevy@szmc.org.il
yet meet the changing world of corporate dominance?
It is customary to ascribe to the head of an organization
"ministerial responsibility" for all that occurs within his
establishment, a term which in itself carries ethical implications. ETHICAL DILEMMA IN THE USE OF INFORMATION
Nevertheless, to date, little attention has been given to defining TECHNOLOGY
the moral responsibilities of the hospital director, who, for the
public, remains a shadowy authority unrelated to more direct Mentor Hamiti

encounters with hospital physicians and staff. Macedonian Unit, UNESCO Chair in Bioethics
In fact, the director is accountable to four distinct entities – his m.hamiti@seeu.edu.mk

patients, his staff, the community served by the hospital and the
In recent years, we have witnessed that ethics is being treated
national health authorities. As such he is the final address for the
very seriously in any modern society. It directly affects the lives
numerous ethical and moral questions that arise daily in the
of communities, family life, human relations, democracy and all
many‐faceted functioning of the hospital. Assessing the
social areas, including education and research institutions. It is
circumstances surrounding exceptional medical outcomes such
worth mentioning the current trend of enriching study programs
as maternal death, .prioritizing admissions to departments of
with courses dedicated to ethics. Moreover, research centers and
limited size, allocating scarce financial resources, introducing
professional units are continuously emerging as well as many
new technologies and medications, weighing professional skills
international conferences are organized, where ethical issues are
against unsatisfactory bedside manner, maintaining good inter‐
examined and explored from different angles.
ethnical relationships, ensuring transparency in reports to the
In this context, the ethics of the use of Information Technology,
ministry of health and sick funds – are discussed in this paper as
considering the large number of users and the differences
examples of moral dilemmas for which the hospital director must
between them, is an important research topic and it deserves
provide definitive responses. Solutions considered appropriate
proper treatment. Therefore, in the framework of this paper is
are reviewed in the perspective of the Israeli Patient's Rights Act,
examined the current trend of internet usage in relation to
1996 and with the proviso that personal judgments, rather than
ethical values. A random survey was conducted at the South East
text book answers, are frequently the ultimate guide in the
European University in Macedonia, where are handled few cases
ethical decisions and moral responsibility demanded by the
dealing with freedom of expression while online, privacy and
position of hospital director.
anonymity issues and up to cases that are categorized as
computer crime. Also we requested an answer to the question of
what to expect in the future and how to support users in
maintaining ethical values when using Information Technology!

LAST RIGHTS: END OF LIFE DECISIONS IN CANADA Aim. The aim of this study was to review the history and
evidence‐based literature regarding SPT, describe and provide a
Mark Handelman model for ethical SPT practice, and present two case examples
University of Toronto, Canada illustrating ethical concerns.
m.handelman@sympatico.ca Methods. Literature review and report of clinical experience

were the methods used.
In 2013, The Supreme Court of Canada heard the appeal of two
Main Outcome Measure. Results of literature review and clinical
intensive care physicians who argued that withdrawing life‐
experience were assessed for this study.
sustaining treatment they said offered no medical benefit to the
Results. Sex therapy pioneers Masters and Johnson introduced
patient did not require the consent of the patient’s surrogates
surrogacy in sex therapy; however, there is a lack of published
because something offering no medical benefit is not a
evidence supporting treatment efficacy and ethico‐legal
“treatment.” The physicians were unsuccessful in both lower
questions have limited the practice from becoming a common
courts and in the Supreme Court. This presentation examines the
intervention. SPT can be an effective intervention that may
Supreme Court rationale and the consequences, in Canada, of
enhance sexual medicine practice. However, SPT must be offered
that Judgment.
according to legal, professional, and ethical standards.
Conclusions. Sexual medicine practitioners should consider SPT
based on the ethical paradigms offered, and sex therapy
BIOETHICS EDUCATION OF A DIVERSE STUDENT GROUP:
practices utilizing SPT should collect and publish outcome data.
DEVELOPMENT OF A CURRICULUM

Jonathan Hellmann1,2, Rebecca Greenberg2, Dennis Scolnik2,

Helen Stolte2, Celine Kim2, Randi Zlotnik Shaul2 CAN PREVENTION OF EATING DISORDERS BE
1
University of Toronto, Canada REGULATED? ISRAEL'S "MODELING ACT" AS A CASE
2
The Hospital for Sick Children, Canada STUDY
jonathan.hellmann@sickkids.ca
Galya Hildesheimer, Hemda Gur‐Arie
The WHO calls for stronger cross‐cultural emphasis in medical Peres Academic Center, Israel
training. Bioethics education can build such competencies as it ghildes@inter.net.il
involves the conscious exploration of values and principles. Since
2004, The Hospital for Sick Children, Toronto has conducted a The Limitation of Weight in the Modeling Industry Act, 2012 is an
‘health through peace’ 4 week elective in Paediatric Emergency innovative legislation initiative, aiming at combating eating
Medicine for Canadian, Israeli, Jordanian and Palestinian (3 each) disorders. The Act places two major limitations upon the
students encompassing 4 elements: clinical shifts, leadership, modeling industry: first, the Act restricts employment of models
global health and peace building. The elective fosters dialogue of a BMI below 18.5, and second, the Act requires placing upon
and cooperation via lectures and seminars in addition to students ads a noticeable disclaimer specifying that digital editing (such as
living and working together. In the past two years a formal "photoshop") has been used to reduce body sizes of models.
bioethics component has been incorporated into the program The motivation behind this law is to limit the presentation of
based on a perceived need by emergency department faculty. unnatural body images and to restrict the exploitation of ultra‐
We sought to determine what such a bioethics curriculum should thin models. The legislators assume a direct link between public
contain and how to evaluate it. Semi‐structured interviews were exposure to slim models and the rapidly increasing rates of
conducted with the students of 2013 to determine ethical issues eating disorders in western societies especially among women
arising in their country of training and in the elective, and with and female adolescents. In a desperate aspiration to adopt
the 2014 students to evaluate the bioethics teaching in the unnatural and unhealthy looks of digitally altered images of
elective. A secondary objective was to determine how cultural models or of underweight models, some women presumably
differences affected their experience. Focus groups were also engage in health detrimental dieting, which may further develop
conducted with elective supervisors. into eating disorders.
We obtained insights into students’ conceptualization of bioethics, Although Israel is the first country to adopt such legislation, not
their perceived bioethical needs, preferred formats and evaluation much can be inferred from the Israeli experience. In this paper,
of the teaching. Faculty responses largely resonated with students’ we wish to elaborate upon major limitations of the "Modeling
identified needs and formats. Despite the complexities and Act". Inter alia, we claim the law to be of a narrow scope, under‐
contextual realities of students’ home environments there was enforced and only partly effective. We additionally wish to
broad agreement on key topics, preferred learning formats and discuss whether legal intervention is an appropriate mechanism
assessment. Also apparent was student engagement and to combat the social causes of eating disorders, or more broadly,
appreciation of opportunities for bioethical discourse during the whether freely adhered to social practices can and should be
elective alongside their clinical teaching. regulated?

SURROGATE PARTNER THERAPY: ETHICAL DOCTORS AS BYSTANDERS DURING THE INDIGENOUS
CONSIDERATIONS IN SEXUAL REHABILITATION MEDICINE AUSTRALIAN GENOCIDE

2,3 2
Rafi Heruti , Ronit Aloni , Talli Rosenbaum 1 Peter Honeyman
1
Inner Stability, Ltd., Israel Sydney University, Australia
2
Tel Aviv University, Israel phoneyman@gmail.com
3
Reuth Medical Center, Israel The British colonization of the Australian continent, starting in in
heroti@reuth.org.il 1788, is now judged to have been an invasion accompanied by

Introduction. Surrogate partner therapy (SPT) is a controversial genocide. The violence, disease, displacement, and removal of
and often misunderstood practice in Sexual Rehabilitation children from families, led to the collapse of the indigenous
Medicine, especially from the ethical point of view. populations and their cultures.
Doctors arrived with the first and subsequent fleets, cared for Assessment drives learning is a known fact. Since there is no
and recorded the health and mortality of the populations. This assessment the will to learn or even to attend bioethics
presentation questions the ethical performance of the doctors class/sessions will be seen as an added burden unless it is
and their organizations in relation to these events. This is done mandated by the regulatory bodies and an examination is
through timelines of the genocide, the growth of the profession, conducted in this subject. However, that may not yield the
and the enlarging ethical expectations, up to current times. desired learning and the effect or sensitization needed. To do so,
The doctors acted as bystanders to the genocide, recording the we need to inculcate ethical thinking by creating interest for the
disease related causes of the indigenous decline. A few doctors subject and learning. We need to sensitize medical and health
joined the fashion of comparative anatomizing of indigenous sciences students regarding the bioethical principles and their
remains, but this activity, including the large volume export of importance.
skulls, was generally undertaken by non‐medical scientists. Hence with a view to kindle interest and also to make students
Hospital care was segregated till the 1960’s. Changes have learn in a fun way, some unconventional and innovative methods
occurred from the 1970’s onwards that have shifted the profession were tried and explored as a voluntary optional add on. These
to better identifying the continuing health disasters of the included movies, newspaper clippings and discussions based on
indigenous population and to actively campaigning to improve. current issues, debates and even a skit competition. The initial
The current medical profession could learn to be more vigilant in feedback seems to be very encouraging and the response is
preventing any population being defined as inferior in the need good. This paper would narrate the evolution, experience,
for medical care. The topical Australian example is the campaign methodology and challenges in implementing innovative
to ensure refugees, deemed illegal, do not receive reduced teaching learning methods for bioethics.
standards of medical care.

CHILDREN IN ARMED CONFLICTS AND CHILD SOLDIERS IN
THE STUDY AND ANALYSIS ON THE PRINCIPLE OF AFRICA: HUMAN RIGHTS AND ETHICAL ISSUES
RESPECT IN THE FORENSIC INVESTIGATION AND
Istifanus Anekoson Joshua1, Jerry Gabriel Makama1,
IDENTIFICATION
Audu Onyemocho2, Awawu Grace Nmadu1,
Shu Bo‐Qing Huang, Lv Duan, Sheng Gao, Tao Wei, Zhen Li Zainab Muhammad‐Idris1, Farouk Adiri1
1
Kunming Medical University, China Kaduna State University, Nigeria
2
hsbq0806@126.com Benue State University, Nigeria
dristifanus@yahoo.com
Objective: We try to understanding and respect for the views of
the principles of forensic ethics in Yunnan Province, the Children are not simply a biological group but constitute a social
policeman on duty. Put forward some preliminary discussion. group whose history differs depending on whether they are in
Method: Using cluster sampling method to carry on the developed or developing countries such as Africa. Children’s
questionnaire survey to the police in some areas of Yunnan involvement in armed conflicts and Child soldiers are not recent
Province behavior in his work, the investigation time for one phenomena and the African continent is often presented as the
year. hardest hit. In the 1990s, Sub‐Saharan Africa (SSA) was marked
Results: (1) in the police forensic science inspection and by a long series of civil conflicts (in Liberia, Sierra Leone, Somalia,
identification of the suspect, think the need to respect the dignity Burundi, Rwanda, Congo‐ Brazzaville, Democratic Republic of the
of human personality accounted for the total number of the Congo, Sudan, Ivory Coast) and recently insurgency has become
93.5% investigations. (2) in the investigation of the police group, an issue of concern in Nigeria. Children are more likely to become
does not recognise the autopsy process action rough accounted child soldiers if they are separated from their families, displaced
for 87%. from their homes, living in combat zones, or have limited access
Conclusions: Although the forensic police have a higher to education. A child soldier has been defined as a person under
knowledge concepts and behaviors about the forensic ethics, but the age of 18 years who directly or indirectly participates in
sometimes it still needs to be respect is the identification of armed conflict as part of an armed force or group. Seven out of
people to avoid any kind of postmortem conflicts between the nine reports by Human Rights Watch on the use of child soldiers
two parties. in the last ten years concern SSA countries; and it is estimated
that some 300,000 children are today involved in more than 30
conflicts worldwide. They suffer from disruption of their
USING INNOVATIVE METHODS TO INCULCATE ETHICAL education and basic health care, injuries from land mines,
THINKING AND BEHAVIOUR AMONG HEALTH SCIENCE substance abuse, sexual violence in form of rape and post
traumatic disorders among others. This paper examines the
STUDENTS
magnitude of child soldiers and children in armed conflicts in
Animesh Jain1, Princy Louis Palatty2, K. R. Nagesh2, Rashmi Jain3, Africa, the correlates of child soldiers, Human Rights, Ethical and
Mary Mathew1, Ramya Shenoy4 public health issues.
1
Kasturba Medical College, Manipal University, India
2
Father Muller Medical College, India
3
Yenepoya University, India THE JEWISH ETHICAL RESPONSE TO BIOETHICAL
4
Manipal College of Dental Sciences, India DILEMMAS IN THE HOLOCAUST
animesh_j@yahoo.com
Alan Jotkowitz
Health sciences students need to develop a rational approach to Ben‐Gurion University, Israel
solve medical dilemmas that they will face in the future. Just as ajotkowitz@hotmail.com
they learn various subjects to tackle medical problems, they also
need ethics to solve the moral dilemmas that they are likely to Fifty‐nine years ago, Dr Leo Alexander published his now famous
face in their future practice. The current curriculum does not report on medicine under the Nazis. In his report he describes
have medical ethics as a separate subject in any of its courses. the two major crimes of German physicians. The participation of
physicians in euthanasia and genocide and the horrible information which is undesirable to the patient and causes a
experiments performed on concentration camp prisoners in the significant change in his/her life. Bad news is part of various
name of science. In response to this gross violation of human conditions such as a handicap or developmental disability in
rights by physicians, the Nuremberg military tribunal, which children, chronic illness or disability, terminal illness or death.
investigated and prosecuted the perpetrators of the Nazi war The course relates to breaking bad news from the view point of
crimes, established ten principles of ethical conduct in medical the receiver as well as from that of the deliverer. Students learn
research in 1949. Notwithstanding all these important efforts and the SPIKES protocol, meet with physicians who deliver bad news
impressive achievements in understanding the ethical failings of as part of their work, as well as with patients who had received
Nazi physicians, the bioethical community has almost completely bad news and tell the students about their experience.
ignored the moral challenges facing the victims of the atrocities. In addition to lectures, a significant part of the course is held in
These dilemmas and their responses have continued relevance small groups. Each group is led by two facilitators, one of whom
for modern medicine. The responsa of the Holocaust survivor is a physician and the other is a social worker, who collaborate on
Rabbi Ephraim Oshry and other rabbinical figures are a valuable a regular basis as part of their clinical role. The teams that teach
source to help understand the Jewish ethical response to this course come from various specialties, including intensive
unimaginable horror and tragedy. Topics to be discussed include: care of adults and of children, emergency medicine, gynecology,
May one put yourself at risk to save a friend? Can one save one's oncology, hematology and premature births.
own child at the expense of another? When if ever is abortion The last meeting of the course is devoted to end of life care.
and contraception sanctioned in the ghetto? Is euthanasia ever Students learn about spiritual support through an experiential
permitted? And issues related to the survivors. In analyzing these workshop. The course ends with a lecture demonstrating
responsa we can see the high moral standards that the victims breaking bad news in movies, where the film scenes are analyzed
held themselves too in the most trying of circumstances. according to the SPIKES model.
In the workshop I will show the audience a series of movie scenes
that may be of precious value in teaching how breaking bad news
INDIVIDUAL PATIENT RIGHTS AND is described in popular films. We will follow the SPIKES protocol
NEW BIO‐TECHNOLOGIES IN MEDICINE step by step and discuss how these scenes can help the student
to understand and practice the model in clinical situations.
Sanja Jovanovska
UN Political Affairs Officer, Republic of Macedonia
jovanovska@un.org; anubisred5588@gmail.com MASS PRISONER HUNGER STRIKE IN 2014:

This presentation is part of the researcher PHD work, ongoing FROM THEORY TO PRACTICE

under the title “Individual patient rights and new biotechnologies Tami Karni, Baruch Chen, Elinor Goshen
in medicine”. This paper reflects the relation between individual Israeli Medical Association, Israel
patient rights, ethical concepts – as the human dignity, and michelle@ima.org.il; Karen@ima.org.il
biotechnologies used in the area of reproduction. The research
focus in the paper is on particular legal and ethical issues related This summer, hundreds of prisoners participated in a hunger
to sex selective feticide, abortion and surrogate motherhood. strike. Until the strike was ended voluntarily in July, dozens of
Statistical indicators alarms that in some societies there is a prisoners and detainees were admitted to various public
latent, but strong preference of a male child mirrored in abuse of hospitals throughout the country. The management of hunger
biotechnologies. This phenomena has been pinpointed by strikes raises difficult ethical dilemmas. How can a doctor
obvious differences in the proportion between male and female reconcile his obligation to preserve life with the obligation to
newborns in favour of the male ones, which has been artificially maintain human dignity and respect autonomy?
created through abuse of reproductive biotechnologies in The Israeli government proposed new legislation that would
medicine. The deficit of women in some countries has enable authorities to force feed hunger strikers. Against the
progressively increased as evident from the sex ratio of the backdrop of this complex situation, and to bring professional
population. In some cultures, sons are preferred over daughters dialogue and agreement between the various parties responsible
for a number of reasons such as economic, social and religious for the medical treatment of the prisoners, the Israeli Medical
including old age security, property inheritance, prestige and Association held a consensus conference.
power, birth and death rituals and beliefs about religious duties International ethical consensus holds that a prisoner who
and salvation. The findings indicate possibility of relation willingly embarks on a hunger strike is not to be force fed or
between early sex detection and illegal abortions. Deeply, the treated against his will. On the other hand, medical professionals
issues seem to be rooted in women discrimination requiring are challenged by being forced to stand idly by as a patient's
adequate national measures in its addressing. The paper will condition deteriorates, even to the point of death. Other ethical
present the main legal and ethical positions and controversies on dilemmas include the fact that keeping hunger strikers together
the issues, using national, regional and international legal and can foment discontent and peer pressure, but separating them
ethical framework. (especially to solitary confinement) may be undue punishment.
The Israeli Medical Association position recognizes the clash of
interests but states that a physician shall not participate in the
BREAKING BAD NEWS, ETHICS AND COMMUNICATION force feeding of any hunger striker or try to dissuade him from
IN THE MOVIES the action he has freely chosen.
Following the suspension of the summer’s hunger strikes Tel
Ruth Kannai Aviv's Ichilov Hospital received a surprising thank you letter from
Hadassah Hebrew University School of Medicine, Israel Palestinian prisoners who were treated there.
rkannai@gmail.com "We are administrative detainees… and are proud to thank the

medical staff at the hospital and employees who support them,"
In Hadassah Hebrew University Medical School, in the second
"During our hospitalization of over a month we felt there was a
semester of the third year, a course on "Breaking Bad News" is
great deal of interest and concern for our situation and our
taught in 3 concentrated study days. Bad News is defined as
health". "The staff were professional, independent and clearly
shared the values of international human rights", signed Patient autonomy on the other hand is a new concept, and
"Administrative detainees who were on a hunger strike for 63 Jewish law is still trying to define its status. Rabbis who address
days." this concept relate to the value of human dignity, a value that has
sources in the Mishnah and Talmud.
After we conclude that the value of life usually has ethical
WHEN LAW, ETHICS, PROFESSIONALISM AND precedence over autonomy, we have to discuss imposing medical
PSYCHOLOGY COME ALIVE: TEACHING MEDICAL treatment in Jewish law. Imposing medical treatment may be
STUDENTS AN INTEGRATED COURSE BASED ON considered a legitimate option within two different frameworks.
If we define receiving medical care as a religious obligation, we
REAL‐LIFE MEDICAL CASE
may require imposing treatment as we require the performance
Orit Karnieli‐Miller 1, Adi Niv‐Yagoda 1, Edna Katzanelson 1, of other religious obligations. Many Poskim (Jewish halachic
1,2 1,3 4
Tami Karni , Dida Fleisig , Judith Fadlon, Alon Ben Nun , authorities) follow this approach, but it has many difficulties,
1,5
Gad Cohen‐Rappaport both technical and inherent. Another approach to this problem is
1
Sackler School of Medicine, Tel Aviv University, Israel through the obligation to save the other, but here we also face
2
Assaf Harofeh Medical Center, Israel difficulties when the "other" resists.
3 th
College of Management Academic Studies, Israel Rabbi Moshe Feinstein, an important 20 century Posek objects
4
Sheba Medical Center, Israel to force feeding and interprets "imposing" as trying to persuade
5
Shalvata Mental Health Care Center, Israel the patient. On the other hand, Rabbi Yitzchok Zilberstein, a
oritkm@gmail.com contemporary Israeli Posek, claims that if we can save the
patient's life we can take any measure required, including
Teaching medical students that relevance of law, ethics, imposing treatment.
professionalism, communication, and psychology is a challenge.
It creates the need to learn new concepts, theories, ways of
dealing with a situation and understanding complexity. Usually PICK‐UP BABIES – SURROGACY IN THE DEVELOPING
each of these topics is taught separately, in a short, introductory,
WORLD: NEW TECHNOLOGIES, OLD EXPLOITATION
theoretical course. Within these the relationship between the
different disciplines, the similarities, contradictions and their Tamar Katz Peled
ability to help understand complexity in medical interactions is University of Haifa, Israel
rarely discussed. tamarpeled@gmail.com
This presentation will focus on an integrated course that includes
the use of a "real‐life" medical case analysis from the Surrogacy in countries as India, Ukraine, Georgia and Armenia
perspectives of medical law, ethics, psychology, sociology, form part of international new‐born trade: Pre‐embryos created
communication and professionalism. Seven scholars from five of reproductive cells extracted from people around the world are
disciplines present their perspectives on key features of a implanted in poor surrogate mothers in the developing world and
medical case of an 82 year‐old woman (and her adult children) delivered to clients. The moral attitude to this practice is
faced with a decision about her treatment, after being admitted community‐specific and is the outcome of legal, social and
to the surgical ward for an esophageal tumor. cultural narratives which explain the phenomenon.
Each discipline provides a unique perspective that emphasizes In order to exploit the surrogate mothers, powerful interested
specific concepts and practical suggestions when understanding parties such as mediators, physicians and aspiring parents use
and dealing with this case. Utilizing the case scenario from the media to disseminate narratives which void the humanity and
different disciplines and integrating the different perspectives maternity of the foreign surrogate mother. According to their
exposes the complexity and dilemmas within medical tales: Since the implanted embryo does not belong to her
encounters, encourages a broader view of the social and cultural genetically she is just a biological incubator; The surrogacy is an
influences that play a role in medical care and facilitates act of free will and compensation is fair (about 7,000 USD in India
discussion of applicable tools. The multidisciplinary analysis as opposed to 35,000 USD in Israel and the USA).
demonstrates the value of crosstalk between disciplines as‐well‐ In practice, as my PHD dissertation shows, surrogate mothers in
as the contribution of each discipline. developing countries are birthing slaves: Without international
regulations they are subjected to dangerous medicines and
procedures with severe implications. In India they are kept away
FORCE FEEDING HUNGER STRIKERS IN THE JEWISH LAW from their families. Their chances to conceive are minor but the
meagre compensation is paid only after delivering a live infant
Yisrael Katz (often by primitive Caesarean section). They choose surrogacy
Clalit Health Services; Hebrew University, Israel because of poverty, and their understanding of its implications is
yshkatz@gmail.com questionable. The newborn may be abandoned without identity
or caregivers. Local surrogacy laws (like Israeli) can’t properly
A hunger strike is defined as a deliberate refusal to eat, supervise international arrangements. I suggest an international
undertaken in protest against imprisonment, objectionable treaty of co‐operation in respect of inter country surrogacy.
conditions or other reasons. To deal with the hunger strikes some
countries have adopted methods of force feeding. Several
international conventions relate to these methods as torture. In
Israel, a new law proposal suggests allowing force feeding in
special circumstances.
In this paper I present the Jewish law principles concerning force
feeding.
The main ethical dilemma in this issue is between autonomy and
the value of life. Jewish law gives supremacy to the value of life.
Only in extreme cases may other values be considered, such as in
the case of a terminal patient with severe pain.
CULTURAL BLINDNESS – POTENTIAL PITFALLS FOR consciousness of choice in relation to self and to others. An
PSYCHOLOGISTS, PSYCHIATRISTS AND PEDIATRICIANS individual's choices integrate emotion and cognition. That ability
WHEN DIAGNOSING ETHIOPIAN CHILDREN to integrate alongside the capacity for choice enables the human
race to act in accordance with ethical and moral codes.
Edna Katzenelson At work, on a daily basis, a doctor is positioned opposite the
Tel‐ Aviv University, Israel physical, emotional, cognitive and ethical entirety of the patient.
ednak@post.tau.ac.il Beyond the doctor's technical ability to heal, there also exists the
capacity to create within the patient the desire to heal
Diagnosing children from other cultures poses a serious challenge themselves and to nurture within the patient the emotional and
to mental health and medical experts from professional and ethic mental coping skills that constitute part of the process of physical
point of view. Pre‐existing stigmas regarding people different healing. The doctor acts as a catalyst for healing not only through
from ourselves can be found both in the conscious and the technical knowledge but also through the ability to reach the
subconscious. Some stigmas are expressed through miming, body patient on an emotional level.
language and verbal and nonverbal signals. They are created by The practical implementation of the quadrangular cluster –
viewing the other as “unlike ourselves,” through social exclusion emotional intelligence, morals, ethics and bio‐ethics – is
(marginalization) and the assumption that anything different is dependent upon the instilling of these principles beginning from
necessarily worse or negative. Mental health professionals must pre‐school age and conducted with even greater intensity during
be aware of their own stigmas and stereotypes concerning medical training and throughout a doctor’s career. The practical
patients from other origins. steps to effective implementation demand experiential and
As an example of this phenomenon, we will present certain applicable teaching of these subjects to students in the medical
mistakes made by psychologists in Israel in their diagnosis of faculties (and to practicing physicians through specially focused
children who themselves, or whose parents, moved to Israel training) so that these principles will be assimilated and became
from Ethiopia within the past 30 years or so. an integral part of a doctor's daily professional conduct thereby
The diagnostic mistakes made in relation to Ethiopian children contributing to the quality of medicine and medical care.
are rooted in unfamiliarity with the children’s native culture and
a lack of culturally appropriate diagnostic tools, both of which
result in erroneous interpretation of the available diagnostic
PATIENT'S RIGHTS LAW AND CULTURALLY COMPETENT
tools applied to the child.
NURSING CARE: AN ISRAELI PERSPECTIVE
I shall bring a number of examples of erroneous diagnostic
conclusions concerning Ethiopian children and discuss the Rabia Khalaila
emotional and educational damage they cause the children and Zefat Academic College, Israel
their families. rabeikh@zefat.ac.il

Aims: The purpose of the current article is to discuss the
EMOTIONAL INTELLIGENCE, ETHICS AND culturally competent nursing practice according to patient's
TIES BETWEEN THEM rights law. It aimed also to suggest strategies and models to
facilitate culturally competent nursing care.
Daniella Keidar Background: According to the patient's rights law, health care
International Center for Health, Law and Ethics, University of providers have to inform the patient about his/her health
Haifa, Israel condition by understandable language and appropriate to their
keidarda@netvision.net.il culture. However, communication with culturally and
linguistically diverse patients has been shown to be difficult.
In recent years, the study of emotions has broadened its scope Cultural and linguistic differences may impede access to health
and established its standing as a new scientific discipline. care, accurate diagnosis, and effective treatment. The culturally
Humanity has become increasing conscious of the seminal role competent nursing approach was suggested as the most
played by the emotional components in both intrapersonal and appropriate way to minimize these difficulties.
interpersonal behavior. A deeply rooted and inherent correlation Conclusion: This paper contributes to nursing care quality by
exists between emotional intelligence (E.I. – Emotional suggesting best available standards and models of care to
Intelligence) and positive social results: social adaptation, quality improve culturally appropriate care. Nurses should placed
social relationships, the capacity for healthy social behaviors, cultural competence as a priority of care, and protect the
caring, altruism, empathy, enlightened communication and the culturally and ethnically diverse patients' rights.
efficacy and personal coherence essential to moral and ethical
behavior including its manifestation in the sphere of bio‐ethics.
The importance of the personal relationship between the doctor
ETHICAL DILEMMAS IN THE PREVENTION OF PTSD
and the patient is especially fundamental in the current era of
AMONG VOLUNTEERS RESPONDING TO TRAUMA
immense and accelerated scientific‐technological development
forcing doctors to cope with an increasingly complicated Haim Y. Knobler1,2,3,4,5, Eli Jaffe4,6, Yoram Blachar2,3
technical environment. Precisely because of this reality, it is 1
Hebrew University Hadassah Medical School, Israel
essential that a doctor's actions and interpersonal relationship 2
Peres Academic Center, Israel
with the patient will proceed from an ethical base grounded in 3
UNESCO Chair of Bio‐Medical Ethics, Israel
both professional and emotional responsibility. Emotional 4
Magen David Adom, Israel
responsibility is one of the central elements underlying bio‐ 5
The Israeli Association for Emotional First Aid (ERAN) , Israel
ethical conduct; it is the element that provides the guideposts for 6
Ben‐Gurion University of the Negev, Israel
the treatment of others. Haim.knobler@gmail.com
The symbiotic connection between emotional intelligence and
the sphere of ethics and morals is what delineates human beings. A major ethical concern is the finding that first responders to
Human beings by definition and in essence bear responsibility for traumatic events are at a special risk of developing mental
their actions. The beginning of ethics is in the human being's symptoms, mostly post‐traumatic.
The aims of this study were to describe the solutions of the JEWISH MEDICAL ETHICS: ON PHYSICIANS' PRAYERS –
Magen‐David‐Adom Prevention Program among volunteers who DEVOTION TO THE LORD, DEVOTION TO THE PATIENT
are first responders to some of these ethical dilemmas.
Ethical aspects of the program were evaluated, in regard to its 3 Samuel Kottek
stages: 1. The primary prevention stage (before the traumatic Hebrew University Medical School Jerusalem, Israel
event); 2. The secondary prevention stage (immediately after the samuelk@ekmd.huji.ac.il

event); 3. The tertiary prevention stage (prompt and effective
In their daily prayers, observant Jews pray to the Lord, three
treatment to symptomatic subjects).
times daily, to allow them to be healed whenever necessary.
The preventive interventions are comprehensive, aimed to
Jewish tradition accords physician the rights and responsibilities
reduce the underlying stress, prevent development of acute and
to healing the sick. This role has often led physicians to be
chronic stress reactions, and screen for those that need
stigmatized for being conceited. In order to counter this risk of
treatment. Therefore, the prevention program addresses the
conceit, several Hebrew medical Oaths and Prayers have been
concern that exposure of first responders to trauma and its' th th
recorded, from the early Oath of Assaf Judaeus (7 ‐8 cent.) to
victims may result in mental traumatization. It also addresses
the Oath for accomplished medical students of Hebrew
some of the other ethical dilemmas.
University, some 70 years ago. A Hebrew paraphrase of the
The MDA Prevention Program addresses basic ethical dilemmas
Hippocratic Oath has been discovered in a 15th century
raised regarding PTSD treatment and research. Future systematic
manuscript and published in 1976.
research has to target issues such as: Is there a place for a
We shall however focus our essay on two Prayers composed by
preliminary treatment by psychotropic medications? How
Jewish physicians for their colleagues, with the aim of curbing
"voluntary" is the subjects' willingness to be included in a PTSD
them toward meekness and obedience to the Lord. They should
prevention/treatment study? Are all PTSD trauma victims able to
be sensitive to the fact that they are forwarding their service to
give a genuine informed consent? How many times may trauma
their patients as a religious duty, while entreating the Lord to
survivors be included in studies? Studies in the field may benefit
assist them in their endeavors. We shall consider and compare
from adopting the PTSD Prevention Program, which attenuates
two remarkably impressive examples. One dates back to 1665,
these ethical dilemmas.
when it was published by the Roman Jewish physician Jacob
Zahalon (1630‐1693), who was also a Rabbi in the Roman ghetto.
th
The other has been attributed to Maimonides (12 cent.), but is
ELIMINATING PRENATAL SEX SELECTION?
now considered as a composition of the German physician
THE GLOBAL AGENDA AND NATIONAL ACTION PLANS Markus Herz and was published in 1783.

Johanna Kostenzer Quite different in size, the two prayers are similar in spirit and
Management Center Innsbruck & University of Innsbruck, Austria interpretation; both are highlights of Jewish medical ethics.
Johanna.Kostenzer@mci.edu They are indeed both enlightening, in the Biblical words of
Zahalon: "In Your light will I behold light" [Psalm 18: 29].
Prenatal sex selection favoring boys over girls has led to a
distortion of sex ratios in several countries across the globe. The
natural sex ratio at birth ranges from 100 to 106 male per 100 TO BE OR NOT TO BE A LIVE KIDNEY DONOR: A PARENT’S
female newborns. However, this ratio has reached levels of up to PERSONAL PRINCIPLE – CAUSE FOR PATIENT’S DEATH
120 for firstborns to 160 or even higher rates for second and
third born children in certain regions. Particularly in China, India Marija Emilija Kukubajska
or Vietnam, but also in some Southeastern European and South University Goce Delcev, Republic of Macedonia
Caucasian countries as Armenia, Albania and Azerbaijan, the marija.kukubajska@ugd.edu.mk

demographic imbalance due to sex selective abortion can be
In the cultural and bioethical process of attitude change towards
observed.
live donor kidney transplant, how could personal character‐
Due to its rootedness in gender inequality and the impact on
principles be a destructive change agent with detrimental impact
women and the society as a whole, the issue of prenatal sex
upon a daughter’s life, after his refusal to be the only compatible
selection is also of concern to the international community.
live donor? The refusal to save the 27 year old life resulted in her
Demography, reproductive health, public security and human
death. Research examines real data: parental impact upon the
rights constitute the main focus areas in this context.
family‐belief‐system of his child, and later upon her death. Case
International organizations but also the relevant countries might
study: Lupus Nephritis final stage renal failure patient (from age
share the need for action but they address the issue from
15), on dialysis for 11 years. Controversial findings point to
different perspectives.
personal ethical and cultural convictions that prioritized concerns
The presentation will shed light on the extent to which
about marital stability and family reaction, to life of his daughter
international organizations as well as the affected nations’
from first marriage. General data is given on Macedonian recent
governments have taken up the matter. Based on a method mix
increase in kidney transplants from live donors, as a positive
consisting of a discourse analysis and observation at international
context juxtaposed with loss of life resulting from self‐centered
conferences, the research concludes with an analysis of the
value systems and rejection of daughter’s plea for his kidney.
international organizations’ and the respective governments’
Sequence of events leading to patient’s death at age 27 are
policy response (eg. facilitative vs. restrictive).
documented in hospital and health care environment settings.

RESEARCH ETHICS COMMITTEES: ETHICAL CONSIDERATIONS REGARDING EVIDENCE‐BASED
FROM THEORY TO PRACTICE AND BACK AGAIN MEDICINE: DOES ONE SIZE FIT ALL?

Josef Kuře Joel Lamoure
Masaryk University, Czech Republic Canadian Section Head, UNESCO Chair in Bioethics
jkure@med.muni.cz director@eim‐care.org

Historically research ethics committees have been established as Evidence based medicine (EBM) has been a template of care and
bodies protecting research subjects. Later also an extended task, decision making since the 1980’s. However, emerging knowledge
namely protection of research institution and protection of in patient centric care and pharmacogenomics has rendered
researchers has been added to their goals. Generally research challenges with the EBM concept. Defined CANMEDS role for the
ethics committees became ethical and legal standard for human clinician as a scientist and communicator, plus health advocate
subject research almost worldwide. The establishment of have advanced clinical practice from Dr. Engel’s bio‐psycho‐social
research ethics committees is governed by hard law in many model in the 1970’s to a new paradigm in decision making for the
countries, by soft law in other countries. Despite the fact that clinician. Ensuring that the right medication is given to the right
research ethics committees became standard instrument for patient helps prevents treatment resistance and enhances
human subject research, there are no universal standards patient functionality, while preventing hospitalization and
regarding their establishing and functioning. The paper deals with medical‐legal and ethical challenges. Are we providing the right
competence and responsibility of research institutions with medication at the right time for the right patient? Does one size
regard to research ethics committees, analyzing the fit all?
establishment and functioning of research ethics committees. Empowering the clinician to effectively critique literature and use
Finally the paper provides some suggestions for improvement of patient centric keys in the patient and family history will lead to a
the system of research ethics committees. more advanced clinical decision making, characterized in
The study was supported by the project CEB: OPVK evidence informed medicine. Effective and goal‐driven care using
CZ.1.07/2.3.00/20.0183. the evidence available and integrating with the patient, family,
inter‐disciplinary team on top of standard EBM templates defines
true evidence informed medicine.
WORKSHOP FOR CLINICAL ETHICS CASE CONFERENCE – In this lecture, clinicians will be provided a review of bias and the
HOW SHOULD IT BE HELD? basics of critical review. In the second part of the course
pharmacogenomics, personalized medicine and drug interactions
Mitsuyasu Kurosu will be explored and addressed. The third piece of the course will
Tokyo Medical University, Japan be a practical, hands‐on group dynamic addressing patient cases
krs‐uou@tokyo‐med.ac.jp and approaches to therapy from an evidence informed concept

to derive an ethical provision of health.
In Japan a clinical ethics case conference has been held in some
hospitals. We held workshop for clinical ethics case conference
two times in our university hospital in 2014 to familiarize clinical

MOTHERING FOR MONEY:
ethics case conference in medical facilities.
I studied how it should be held to hold the conference REGULATING INTERNATIONAL INTIMACY

continuously. Two clinical ethics case conferences, which were Pamela Laufer‐Ukeles
held in 2014, were analyzed and their improvements were University of Dayton School of Law, USA and Bar‐Ilan University,
distilled. The first conference: 34 participants, 11 stuffs, 6 or 7 Israel
persons per group, 5 groups. Members of each group were 2 or 3 Plauferukeles1@udayton.edu
doctors, 2 or 3 nurses, and others including ethicists, medical
anthropologist, education stuffs of pharmaceutical companies, In this presentation I will consider both the ethical dilemmas that
care manager and so on. The schedule was as following; make surrogacy such a controversial process and also consider
introduction of Japan Unit of the International network of the great benefits of the process as well as the low levels of
UNESCO Chair in Bioethics, self‐introduction, explanation of 4 litigation that have resulted. I will argue that what makes
boxes method (by Jonsen et al), group and plenary discussion of surrogate motherhood such a complex process is that it
two common clinical cases and 5 cases which were offered by the embodies commercial intimacy. It is both a job for hire and yet,
participants. Many participants attended at the get‐together pregnancy, is an intimate process that is closely connected with
meeting after the conference. personhood. I will argue for a “mixed commodification”
The second conference: 17 participants, 9 stuffs, 4 or 5 persons perspective on surrogacy that both recognizes the vulnerability
per group, 6 groups The differences from the first conference that needs to be protected due to the intimacy involved and the
were as following; participation of many doctors and a few fundamental and ultimately useful commercial nature of the
nurses, group and plenary discussion of one common clinical process. Therefore, I argue for a regulated system of surrogacy
cases and 4 cases which were offered by the participants. that protects the human dignity of the surrogate and the over
Conclusion: A group should be composed of over 4 kind commodification of the body. With this conceptual background, I
occupations. For half day a conference should be composed of 4 will focus on international surrogacy particularly as practiced in
groups, one common clinical case, 4 participant‐clinical cases. 4 India, but in other countries as well. I will argue that international
boxes method is useful. A get‐together meeting after the surrogacy is much more likely to exploit and over commodify the
conference is beneficial for information exchange. human body and thus is in need of strict regulation as well as
national openness to allowing domestic surrogate systems
instead of allowing citizens to look to employ women abroad.

REFORMING THE LAW ON SURROGACY IN VIETNAM complex ethical issues arising in similar cases.
I will make three normative claims. First, that in contrast to
Tung Le Xuan Daniel Nadav, we can and should judge those who faced this kind
University of Southampton, UK of dilemmas in the past, in the hope of learning from their past
Tung1911@yahoo.com; tlx1g11@soton.ac.uk misguided moral decisions and better guide future ones. Second,

that hurting persons for the sake of saving one’s life or the lives
Surrogacy is prohibited in Vietnam for the time being. This
of those who are close to one is immoral. Third, that hurting
prohibition has caused many worrying problems for the
persons with the intention of eventually benefiting them or other
Vietnamese society. For instance, the emergence of the black
potential victims is morally acceptable.
market, where surrogacy arrangements have been made
between infertile people and brokers or surrogate mothers, has
put the welfare of concerned parties (infertile couples, surrogate

mothers and children born of surrogacy) at risk. There were cases SURROGACY, THE DEBATE IN ISRAEL AND FRANCE IN
where Vietnamese women, who were lured into surrogacy CULTURAL AND HISTORICAL PERSPECTIVES

arrangements and acted as surrogate mothers, became victims of
Etienne Lepicard
physical violence or subject to human trafficking across borders.
School of Health Professions, Ashkelon College, Israel
The increasing incidence of surrogacy as reported by the Ministry
elepicard@gmail.com
of Health of Vietnam shows that the current ban on surrogacy
seems to be uneffective and the need to reform the law on While surrogacy had been legalized in Israel since 1996, it is to
surrogacy is urgent. this day one of the heated debates on reproductive technologies
There are many reasons which may be accounts for the use of in France. After recalling the historical setting that brought Israel
surrogacy by Vietnamese infertile people in spite of the to be one of the first countries that legalized surrogacy, I will look
prohibition of surrogacy. From cultural and social perspectives, to after possible cultural and historical reasons that may explain the
have genetically related children is regarded as a social duty in differences in public reaction between France and Israel. For this
Vietnam. Even infertile people strive to have their own biological purpose, I will look on one hand, at the difference of status
children in order to continue their family line, to show respect for bioethical debates enjoyed in France and Israel, especially
their parents and ancestors, and more and less importantly, to looking at the role played by bioethics councils in arousing a
maintain their marriage. The childlessness of a married couple public debate in both countries. And on the other hand, I will
might result in a divorce. Allowing surrogacy, therefore, would look on how deeper cultural and religious roots had been
facilitate Vietnamese infertile people to exercise their right to mobilized in the two contexts. Finally, as one of the main
procreate (with the help of assisted reproductive technologies) in characteristics of surrogacy is the distance maintained between
the pathway to biological parenthood. the emotional and the physiological contexts of human
A few months ago, the National Assembly (Parliament of reproduction, I will check the tentative performed by the Nazis in
Vietnam) amended the Law on Marriage and Family 2000, their project of arising “perfect children” within the Lebensborn
permitting surrogacy in Vietnam (which will come into force from institutions and its links – or absence of links – to the current
1st January 2015). However, surrogacy arrangements are only topic and debate.
legally permitted between sister first cousins. The problem is that
some infertile women do not have sisters, and in some
circumstances, sisters do not want to be surrogate mothers. That TRUST AND ETHICS IN THE PHARMACEUTICAL INDUSTRY:
means that the situation still remains and the legal permission of WILL A RATING SYSTEM HELP?
surrogacy as such hardly enables infertile people in Vietnam to
fulfil their dreams of having their own biological children through Marie Catherine Letendre1, Jennifer Miller2
1
surrogacy. Consequently, the law on surrogacy in Vietnam still Bioethics International, USA
2
needs a further reform. Duke University, USA
mariecletendre@hotmail.com

Numerous studies have shown that transparency in drug research
MORAL RESPONSIBILITY DURING ATROCITIES:
is low, including and perhaps particularly in the dissemination of
THE YUANA KEN CASE STUDY

clinical trial results for newly approved medicines and vaccines.
Zohar Lederman Gaps in trust and ethics continue to challenge the bio‐
National University of Singapore, Singapore pharmaceutical industry, providing fodder for the media and
zoharlederman@gmail.com provoking chagrin from consumers — including concerns about the
quality and accessibility of medicine, essential life‐saving therapies
In the 1930’s and 1940’s, the Japanese Unit 731 conducted the and human research subject protections. Curiously, despite the
most elaborate and rigorous medical experimentations in number of publicized breaches of trust and ethics, we’re in an age
biological and chemical warfare in history. In their resulting peer‐ that demands excellence in health care ethics in developed
reviewed publications, the Unit’s researchers listed their subjects countries. We’re also concerned that the poor in developing
as monkeys, but now, (as well as back then) it is well known that countries aren’t used solely as means to an end. Yet the practicality
these subjects were human beings, mostly Manchurian Chinese. of articulating, ensuring, monitoring and evaluating excellence in
More than half a million innocent civilians were “sacrificed” by ethical standards remains both a challenge and an opportunity.
scientists and medical clinicians. Bioethics International proposes a rating system. This initiative is
In this paper, I will discuss the moral responsibility of medical both timely and representative of the cultural changes in the
professionals involved in genocides and atrocities. I will use as an health care sector. A culture of trustworthy innovation mirrors the
example the experiments conducted by Unit 731, first providing a words of Aristotle that “we are what we repeatedly do. Excellence,
brief historical overview. I will focus on a particular individual, then, is not an act but a habit.” BEI’s initiative is committed to
army surgeon Yuana Ken, who actively participated in these providing a practical tool to attain excellence because in matters of
experiments and later repented. His situation as a soldier on the health and life, just enough isn’t good enough.
one hand and a researcher‐healer on the other illustrates the
ASSISTED REPRODUCTIVE TECHNOLOGIES AND prostitute. In light of these claims, I argue for a new model for
PARENTING RIGHTS IN A JEWISH DEMOCRATIC STATE: institutionalization of prostitution, which includes inspecting the
THE CASE OF THE OVA DONATION LAW process leading one's decision to prostitute and an active
protection of the prostitute during the sexual servicing.
Ori Lev1, Arnon Keren2
1
Sapir Academic College, Israel
2
Haifa University, Israel THE ORGAN SHORTAGE AND ITS CONSEQUENCES:
Orilev22@mail.sapir.ac.il LEGAL AND ETHICAL REFLECTIONS ON STATE INCENTIVES

In light of the significance of reproduction to many people's lives, AS POSSIBLE REMEDIES

the right to reproduce has been widely recognized. However, Melanie Levy
many couples are unable to reproduce naturally. Artificial Tel Aviv University, Israel
reproductive technologies (ARTs), such as ova donation, can help melanie.a.levy@gmail.com
such couples. Interestingly, unlike natural reproduction, which is
usually not subject to legal regulation and prohibitions, as long as Organ transplantation is a very successful medical procedure,
it is performed by consenting adults, many governments tightly which saves the lives of thousands of patients worldwide every
regulate the use of ARTs, and place limitations on their use. Can year. However, this success is limited by a major problem: a
the greater extent of governmental regulation of the use of ARTs chronic shortage of transplantable organs. Here we consider the
be justified? And if so, what kind of considerations can justify medical, social and economic issues raised by transplantation
such regulation? medicine and define organ shortage as a public health problem.
By examining the Israeli Ova Donation Law (2010) as a case study The organ shortage and its serious consequences on patients and
this paper attempts to shed some light on the kind of society open up the question of the role of the state in the
considerations that might justify limiting the use of ARTs. We context of transplantation medicine. This leads us to analyze the
argue that while greater regulation of the use of ARTs, as possibility for the state to promote organ donation with
compared with natural reproduction, is justified, there are also incentives, i.e., regulatory instruments to reward organ donation,
significant limitations to a government's ability to legitimately in the context of a public policy. We show how these incentives
interfere with consenting adult's reproductive choices. The paper can be designed to increase organ donation rates and present
proposes that the law’s prohibitions on ova donation from several innovative incentives such as tax breaks for willing
married women and on inter‐religious donations—prohibitions donors; priority status on the waiting list for a registered donor
that were intended to prevent harm from children born through should he or she ever need an organ transplant; discounts on
the use of ova donation—are unjustifiable. On the other hand, health insurance premiums; or a rebate on a donor’s funeral
the legislature was right to remove from the law the previously costs. Considering the legal and ethical framework in which these
existing prohibition on ova donation from volunteers who are not incentives have to operate, we conclude that legal and ethical
undergoing fertility treatment—a prohibition that was intended constraints can be addressed by carefully choosing the modalities
to prevent harm from such volunteers. of these incentives.

THE AUTONOMY QUESTION OF THE PROSTITUTION: THE APPLICATION OF BIOETHICS PRINCIPLE ON FORENSIC
AN INTEGRATIVE MODEL MEDICINE

Renana Leviani Zhen Li, Canping Wang, Ruihong Zhang
Bar Ilan Univeristy, Kibbutzim College of Education Technology Kunming Medical University, China
and the Arts, Israel sakmu318@foxmail.com
renanaleviani@gmail.com
UNESCO bioethics institute committee go to the southern and
The phenomenon of prostitution has been debated intensely in western district (city) and county in Yunnan province, to take a
moral philosophy. In my perspective, the core of the significant investigation about forensic ethics and health condition priority
aspects of that debate is the autonomy question of the prostitute to with forensic policemen of public security, procuratorial
and the different approaches of interpreting it. system on‐the‐job police. Group using self‐designed
Based on that, throughout the lecture I examine the questionnaire overall sampling survey method in 2013 to 2014 in
phenomenon in the light of the autonomy question and divide China many times, on‐the‐job police in Yunnan province in
the central critique towards the phenomenon into two respect of forensic ethics principle, the principle of informed
distinguished categories. The first category is the substantive consent, confidentiality, fair and just principles, such as
critique. According to that critique, the idea of selling sexual knowledge structure, the state of consciousness, attitude and
services stands in an essential contradiction with the autonomy behavior, to prove the current forensic knowledge of ethics,
term. I include two components in this critique, the sexual ethical consciousness and behavior, and the results were
enslavement and the attitude towards the prostitute. analyzed, and find problems existing in current forensic work
The second category is the practical critique of the prostitution. ethics, improving Suggestions about the present situation of
This critique undermines the autonomy of the prostitute due to current forensic ethics in Yunnan. In addition, here is so many
diverse variations that frequently accompany with the minority population and ethnic minority areas throughout the
phenomenon. This critique has two components. The first province, the various ethnic minority areas have different
focuses on the procedural aspects of making the decision to work customs, local forensic workers should take forensic judicial
as a prostitute. The second contains the physical and emotional authentication work on the basis of respecting local customs,
harms might be caused by prostitution. which is of great significance to safeguard national unity, we also
Grounded on that, I argue that although in some cases this carries on the analysis and research to this, in order to
phenomenon accompany, in the current situation of the understand the status quo, and the guidance of judicial
prostitution, with harsh circumstances and harms, the idea of authentication work of ethnic minority region.
selling sex itself does not contradict with the autonomy of the
A PATERNITY CASE WITH MULTISTEP MICROSATELLITE founding myths of Western culture, that of Prometheus. We will
MUTATIONS IN LOCUS D5S818 first address three famous variations of the ancient myth: 1)
Goethe’s poem (1772), 2) Mary Shelley’s novel Frankenstein: The
Hong Liang, Hong Du Ma, Jie Yang Modern Prometheus (1818), and 3) Franz Kafka’s short piece
Kunming Municipal People’s Procuratorate, China entitled “Prometheus” (1918). Our understanding of this myth
532161481@qq.com would help us to narrow the pathos involved in every bioethical

dilemma and give us the chance to reflect on the scope of our
Mutations of STR loci have been observed and reported during
human actions in the fields of recent scientific‐breakthroughs. As
the paternity testing. However, single‐step mutations account for
a relevant bioethical example which can be better understood
about 90% of STR mutation events. It was very rare that
through the myth of Prometheus, we will in the second part of
multistep mutations occurred at a STR loci. Here we show a non‐
the paper consider the power of creation involved in the process
exclusion paternity case with multistep mutations in the locus
of assisted reproductive technologies. Reprogenetics, we can say,
D5S818. The composition of the alleles of this locus in the
is the post‐modern Prometheus: the development of assisted
suspected father, mother, the questioned child was 13, 11/13
reproductive technologies has changed the world as we knew it
and 7/13, respectively. The sequence analysis of the regions
and we should be aware of this power. Located In‐between
flanking the locus D5S818 of the suspected father, mother and
chance and necessity, the concerns of reprogenetics present to
the questioned child excluded the possibility of null allele as a
us with significant questions dealing with the evolution of our
cause of the allelic mismatch in the child. A total of 39 autosomal
human condition and an erosion of the foundations of the
STR loci were typed using three Commercial kits and the
9 “traditional family model.” The human being is an extraordinary
paternity index is up to 2.461×10 . Furthermore, genotyping of
creature, essentially unique and singular; something of its
sixteen Y chromosome STR loci in the questioned child matched
intrinsic value might be found there. Finally, through the analysis
completely with the suspected father. These results proved
of certain scenarios, in which science, law, and ethics are
conclusively multistep microsatellite mutation in the maternally
intertwined, we will revisit the title of an etching of the Spanish
or paternally transmitted locus D5S818 of this case.
painter Francisco Goya: “The Sleep of Reason produces Monsters
“(1799). This title contains multiple meanings, but the one in
terms of which we understand the heart of the problem with the
A WOMAN'S RIGHT TO ABORT A VIABLE FETUS contemporary bioethics is (as Michael Foucault expressed it) that

Pnina Lifshitz‐Aviram of “the circulation of power over bodies.”
Israel
pninaaviram@gmail.com

THE APPLICATION OF PUBLIC SECURITY, PROCURATORIAL
What underlie the terms "healthy" or "perfect", is one of the POLICEMEN HEALTH SURVEY IN ETHNIC MINORITY AREAS
questions I wish to examine, when discussing the dichotomy IN YUNNAN PROVINCE
between a woman's right on her own body, and the fetus right
for life at the viable stage of pregnancy. I ask if protecting the Xuecheng Liu, Zhen Li
future rights of a fetus is a value worthy of society's and judicial Kunming Medical University, China
system's protections, or whether it is the woman's dignity, lxc_snowden@126.com
freedom and autonomy in selecting her siblings that outweigh
those of the fetus. We investigate the healthy condition of the forensic police in
I seek to discuss judicial terms and rights (woman versus fetus), Yunnan Province. The investigation included the subjective
but not only. I wish to discuss ethics, moral, philosophy and understanding of their health, objective indicators (blood
values. pressure, blood sugar, blood fat), living habits (smoking, drinking,
The fetus should have the right to be born and lead a healthy life, eating, sleep), the psychological state of self‐awareness and
and this right may outweigh the right of the woman to terminate evaluation of the work environment, etc. Team overall sampling
the pregnancy. A fetus unable to express its desires does not survey by self‐made questionnaire on the results of the survey, to
equal a "right‐less" entity. Some may claim a comatose person is understand the current forensic police health status and the
also "right‐less" and many will use the term "vegetable" – but will existing problems and risks, further on the forensic police work
they even think of bringing this life to an end because of it? Some environment, work mode, life style, etc. improvement opinions
will also claim that a patient with Alzheimer's disease is "right‐ and suggestions are put forward.
less" – should we end this life as well? Can society decide when a
being unable to claim its rights has no longer right for living?

In my view, we as a society, should respect the potential of life of THE EFFECT OF VALUES AND CULTURE ON LIFE SUPPORT
a viable fetus and protect it even from its parents. DECISIONS

Theong Ho Low
Australia
BIOETHICS AND ITS PROMETHEAN CHALLENGE

thlow@bigpond.net.au

Natacha Salomé Lima1, Predrag Cicovacki2
1 When patients and health professionals are from different ethnic
2 backgrounds, value systems that form the basis of such decisions
College of the Holy Cross, USA
may conflict. Many cultural groups do not place the same emphasis
lima.natacha@hotmail.com, nlima@psi.uba.ar

on patient autonomy and self‐determination that western society
Contemporary bioethics presents to us huge challenges in several does and finds the idea of terminating life support offensive. This
fields of knowledge. The ever‐increasing technological power to presentation will examine views on life support from varied
interfere with the nature of things (including human nature) cultural views. The presentation will then reveal that by becoming
demands our increased ethical awareness and considerations. aware of the diversity of beliefs, health professionals can avoid the
How are we going to respond to this demand? Our proposal is to damage to the health care professional ‐ patient relationship
address this complex issue through the revisiting of one of the caused by conflicting value systems.
MIDWIVES’ EXPERIENCES ON THE USE OF PARTOGRAM These enhanced capacities will also have the effect of challenging
IN THE MANAGEMENT OF WOMEN DURING LABOUR AT existing ethical boundaries.
LIMPOPO, SOUTH AFRICA Control Measures: The current legal regulations and ethical
guidelines lag far behind the new capacities which converged
T.G. Lumadi technologies will deliver and will require a major overhaul in
University of South Africa, South Africa order to safely integrate the new medical technologies into
lumadtg@unisa.ac.za mainstream medical treatment.
This paper will explore some of the new technologies and their
Partogram has been adopted globally in many countries as a tool ethical demands.
to record maternal and foetal observations in a simple and
pictorial form in order to detect problems, manage and refer for
appropriate treatment early. Partograms are mostly used by
CAPACITY ASSESSMENT IN HEALTH CARE
midwives; hence a qualitative, explorative, descriptive and
PROFESSIONALS: A MAJOR CHALLENGE IN AN AGING
contextual study on midwives’ experiences was conducted at the
three hospitals in the district located at Limpopo Province of SOCIETY

South Africa. Yoram Maaravi1, Lotan Brit2, Eyad Abu Saraa3, Efrat Adler3
Face to face semi structured interviews were conducted with 17 1
Hadassah ‐ Hebrew University Medical Center, Israel
midwives who were purposely selected and working in the 2
Hadassah ‐ Hebrew University Medical School, Israel
maternity wards. The findings were analysed using Tesch’s eight 3
Hadassah ‐ Hebrew University School of Nursing, Israel
steps of data analysis and four themes emerged which are: ymaaravi@gmail.com
benefits of using the partogram, challenges experienced,
attitudes of midwives and evaluation on how the partogram was Human autonomy is universally sacred in western societies. It is
plotted. Several recommendations were made including well accepted that every human is competent for any decisions
emphasis on communication among staff members, education unless proven otherwise.
and training and provision of necessary equipment. Yet our societies are aging rapidly and cognitive abnormalities
related to conditions such as dementia, delirium, depression and
other neuropsychiatric ailments are prevalent.
THE ETHICAL AND LEGAL CONSEQUENCES OF Preserving autonomy in the elderly is becoming challenging and
CONVERGING BIOTECHNOLOGIES is based on knowledge, competency and attitudes of the health
care professionals. Moreover, this autonomy is at the core of
Michael Lupton every patient‐provider interaction and the informed consent.
Bond University, Australia The objective of our study was to assess the knowledge and
mlupton@bond.edu.au competency of physicians and nurses to acquire informed

consent and their ability at capacity assessment.
Definition: The previously distinct and parallel lines of
The study surveyed 207 physicians and nurses in acute care
progression in biotechnological disciplines such as stem cells,
hospitals in Jerusalem. The research tool was a questionnaire
cloning, genetic engineering and nanomedicine are now rapidly
consisting of a skill assessment part with five clinical vignettes
trending towards interconnection and achieving a holistic goal.
examining ability to correctly identify competent and
Convergence on a narrow scale: The convergence of distinct
incompetent patients, and a theoretical part assessing
disciplines such as genomics, cloning, stem cell research and
knowledge through four multiple choice questions.
artificial reproduction can be classified as convergence on a
The average total score was 52.2/100 (±14.5/100) and the skill
narrow scale. The combined power of these biosciences has the
assessment part score was 32.6/100 (±20.4/100). Performance
potential to dramatically increase our understanding of human
was better in the vignettes in which patients were described as
life and provide scientists with the ability to radically manipulate
competent. The average score in the theoretical part was
and transform human nature itself.
61.5/100 (±17.8/100). Less than five percent of participants
Convergence on a broader scale: Convergence on a broader
correctly identified the four commonly accepted criteria for
scale would include nanotechnology, biotechnology, information
assessing capacity.
science and cognitive science (the so called NBIC).
This study demonstrates lack of knowledge and skills for capacity
The consequences arising from this group of converging sciences
st assessment amongst physicians and nurses. Improving
is that it will provide our 21 century society with unique
knowledge and competency of health‐care professionals in
opportunities to enhance human performance on a scale that will
capacity assessment is of high priority in an aging society.
transform society.
The scientific tools created by this convergence is growing
exponentially more powerful. This in turn will result in an

PATIENTS’ PERCEPTION AND ACTUAL PRACTICE OF
increased capacity for speedy innovation and invention way
beyond what currently exists. PRIVACY & CONFIDENTIALITY IN SURGICAL OUTPATIENT
Therapeutic benefits: Society can anticipate that the following DEPARTMENTS OF GENERAL HOSPITALS, KADUNA,
ethically neutral benefits will flow from convergence viz NIGERIA

enhanced pain management, slowing of the aging process,
JG Makama1, IA Joshua1, ES Garba2
replacing of diseased and worn out organs. 1
Challenges arising out of convergence will include the option for 2
University of Abuja, Nigeria
parents to create ‘designer babies’, synthetic genes, genetic
jerlizabeth@yahoo.com
interventions, augmented cognitive power.
Market for Performance Enhancement: The increased capacity Background: The principles of informed consent, confidentiality
arising out of the convergence of the technologies will extend to and privacy are often neglected during patient care in developing
everything from restoring sight and hearing to manipulating countries. We assessed the degree to which Doctors in Kaduna
genetic material resulting in enhancements which will be adhere to these principles during surgical outpatient
desirable to millions around the world. consultations.
Material & Method: The descriptive cross sectional study was law is inconsistent in its declarations and in its definition of the
conducted at surgical out‐patient departments (SOPDs) of principles underlying its approach to the issue of the physician‐
General hospitals [GHs] in Kaduna. Twelve (12) [GHs] were patient relationship. I will argue that law's difficulty in coping
selected using multi‐stage sampling. Thirty three (33) patients with the regulation of the physician‐patient relationship is a
were selected from each hospital. Doctors' adherence to the conceptual‐theoretical impediment created by the relatively new
principles of informed consent, privacy and confidentiality was legal vantage point that is grounded in the ethical field.
observed through client flow analysis performed by trained With the intention of providing an alternative proposal to
personnel. Overall patient perception was also assessed supplement the existing and currently dominant approaches, I
regarding these practices and was compared with the will suggest a theoretical framework that incorporates and takes
assessment made from the practice. into consideration a number of additional elements that
Results: Informed consent was obtained from only 19.7% characterize the physician‐patient relationship.
patients in the hospitals under study. Sixty three percent of
patients in the hospital were accorded some degree of privacy.
Of this number, 75% were female patients. Complete FROM BABY M TO BABY M(ANJI):
informational confidentiality was maintained only in 10.8% cases REGULATING INTERNATIONAL SURROGACY AGREEMENTS
in the hospitals. Informed consent and confidentiality were less
practiced in the hospital than was expected by patients (two‐ Yehezkel Margalit
sample t‐test > 2, p value < 0.05). There was marked disparity Tel Aviv University, Israel
between the patients' perspective of these ethical practices and hzimar@ono.ac.il.

the assessment of the practice obtained in General Hospitals.
The American public’s attention was first drawn to the practice of
Conclusion: Simple ethical considerations at SOPDs of General
surrogacy in 1988 with the drama and verdict of the Baby M case.
Hospitals, Kaduna, were inadequate. Doctors should be imparted
Similarly, three years earlier in the U.K, the drama of Baby Cotton
formal training on medical ethics. Patients should be made aware
was exposed to the public when, for the first time, Kim Cotton
of their rights to basic medical ethics too.
became Britain's first commercial surrogate mother. These two
leading domestic surrogacy dramas involved the most basic
arguments regarding how we should treat surrogacy: as a unique
THE ROLE OF THE ISRAELI COURTS IN FORMULATING THE
and meaningful act of giving life to a barren couple or as an act of
PHYSICIAN–PATIENT RELATIONSHIP dehumanizing and exploiting not only of the specific surrogate

Limor Malul mother, but of women as a whole.
Haifa University; Zefat Academic College; Zefat Forum for Nowadays, troubling dilemmas have evolved around
Bioethics, Israel international surrogacy agreements. The discussion in this paper
limor.mlr@gmail.com centers on whether regulation should be domestic or
international and what is the best approach to achieving it.
The nature of physician‐patient relationships has been In my presentation I will explore the modern dilemma of
documented in the ancient Greek and Roman literature, as well international surrogacy agreements and embedded ethical and
as in that of the Middle Ages and modern times. As far back as in legal pitfalls. I will describe a variety of solutions suggested in the
Hippocrates' writings, ethical dilemmas including those research and I will enumerate their advantages and
concerning patient‐physician relationships, patient consent to disadvantages.
treatment and end of life issues have been raised and discussed. Afterwards, I will suggest articulating a Hague international
Over time, changes have occurred in the dynamic between the convention to regulate international surrogacy agreements
diverse values that are taken into consideration when defining similarly to the existing Hague Convention on Protection of
the therapeutic milieu. The nature of this dyad has moved from a Children and Co‐operation in Respect of Intercountry Adoption.
paternalistic framework that empowers the physician and In my opinion, this is the best legal method to regulate and
emphasizes the patient's wellbeing to an interpersonal address ethical and legal dilemmas of international surrogacy
framework that empowers the patient and is focused on his agreements.
desires and rights. The pendulum of the physician‐patient Finally, I will demonstrate how the recent Israeli expert
relationship is, in each era, continually adjusted in accordance committee, the Shlomo Mor‐Yosef committee published in May
with contemporary social values and by norms that have been 2012, and the proposed 2014 Regulation suggested a similar
shaped by judicial tribunals and legislation. suggestion in the context of domestic regulation, without any
Viewing the issue of physician‐patient relationship as an ethical need for international convention or regulation.
dilemma deeply rooted within social‐cultural contexts, demands
the formulation of a theoretical framework that incorporates the
relevant ethical principles and a system of implementation that THE EVOLUTION OF THE OBJECTIVE CAUSE CONCEPT
constitutes a declaration of intention concerning the values we FROM THE PSYCHIATRIC AND LEGAL POINTS OF VIEW
thereby wish to protect. The current state of affairs’ legal and
legislative arrangements prefer patient autonomy above other Roberto Mester1, Jacob Margolin2
1
significant social values that could provide the foundation for a Tel Aviv University Sackler School of Medicine, Israel
2
more stable, appropriate and fruitful physician‐patient Israel
relationship . This article wishes to critically examine the rmester@netvision.net.il

questions of whether, and in what ways, the law influences the
The characteristics of the of the objective cause concept is
character of the physician‐patient relationship and what are the
undergoing evolutions in the psychiatric and in the legal fields as
implications of such an influence on the medical policy and
can be observed in court rulings and in psychiatric diagnostic
practice. In light of the inconsistency of rulings in this domain,
criteria. In this presentation those evolutions will be analyzed
the necessity to adopt ethical guidelines through legislation and
and discussed using two types of materials: a) a recent Israel
the need for a legal system to constructively and systematically
Supreme Court ruling related to an appeal of an army officer who
balance the diverse ethical approaches regarding the physician‐
claimed to have developed a psychiatric disorder due to his army
patient relationship become clear. As will be argued below, the
service. b) the changes of the (A) diagnostic criteria from the integrative concept of bioethics having a compound social and
DSM‐III, through the DSM‐IV till the recently published DSM‐V. philosophical status.
Awareness and understanding of those evolutions are helpful for Comprehension of the moral perspective of medical profession is
psychiatrist who are in the process or preparing medicolegal the main orienting point of modern human relations in the
reports and/or acting as expert witnesses in court. sphere of medicine and biology. The ideology of the UNESCO
Core Curriculum on Bioethics rests on this postulate, which
determines the motivation for developing a normative and
TEACHING BIOETHICS AND HUMAN RIGHTS methodical platform for harmonizing education in bioethics to
THROUGH CINEMA AND POPULAR TV SERIES: achieve subsequent harmonization in understanding and
A METHODOLOGICAL APPROACH implementing universal bioethical principles in healthcare
everywhere and with due account for the beauty and great
Juan Jorge Michel Fariña1, Moty Benyakar2 variety of cultural and historical tendencies.
1
2
Universidad del Salvador (USAL), Argentina
motybenyakar@fibertel.com.ar LEGAL TREATMENT OF THE RIGHT TO A DIGNIFIED DEATH

IN BOSNIA AND HERZEGOVINA: LEGAL AND ETHICAL
Since its origins, cinema has promoted awareness of ethical
problems. With the expansion of the film industry, these subjects ISSUES

have reached wider audiences, promoting interesting discussions Igor Milinkovic
inside and outside the academic world. Meanwhile, studies of University of Banja Luka, Bosnia and Herzegovina
explicit ethical subjects related to Science and Technology have igormilinkovic@yahoo.com, i.milinkovic@pravobl.com
increased, as has the attention paid to Human Rights problems.
Unfair Discrimination, Multiple Relationships, Conflict of Euthanasia is one of the most controversial subjects in medical
Interests, Exploitative Relationships, Informed Consent, Privacy law and bioethics. Proponents of euthanasia legalization usually
and Confidentiality, Deception in Research, and Forensic Issues invoke the right to a dignified death. In the first part of the paper,
are some of an array of topics that have become central to the the concept of euthanasia will be explained and the basic
conflict presented in numerous films. Furthermore, over the last classifications of this notion will be clarified. Ethical complexity of
few years, this phenomenon has exceeded the limits of the the problem will be explored. Special emphasis will be placed on
movie industry and ethical conflicts have begun to appear the different meanings ascribed to the term dignity by the
regularly in popular television series, in which the ethical opposing sides in the euthanasia debate (on one side are those
dilemmas that arise between a therapist and their patient are who claim that dignity requires a patient’s freedom of choice,
dealt with deliberately and explicitly. Scintillating episodes from including the right to choose the time and manner of his/her
series such as CSI, The Sopranos, In Treatment, House MD and death; on the other side are those who use the concept of dignity
Grey’s Anatomy have brought these matters into the homes of a to defend the inviolability of human life). In the second part, the
far‐reaching and diverse audience. legal treatment of the various forms of euthanasia in Bosnia and
A selection of these materials is currently being used to teaching Herzegovina (its entities: Republic Srpska and the Federation
and to train members of interdisciplinary committees dedicated Bosnia and Herzegovina) will be explained. Current legal
to the question of ethics within the health field of practice. regulations will be compared with solutions accepted in
Regardless of whether the ethical dilemmas are presented in an comparative law (the practice of the European Court of Human
explicit matter through films or televisions series, or the whether Rights will be considered as well). Although the legalization of
the audiences themselves infer moral or ethical issues that the active euthanasia does not seem realistic at the moment, certain
director may not have intended to present, utilizing these legislative changes are necessary in order to facilitate dealing
resources as a means for exploring these issues lends itself to an with practical problems in the terminal patients' treatment. The
extraordinary opportunity for academic thought and reflection. deficiencies of the current criminal legislation will be pointed out,
as well as possible changes in other fields of law relevant for the
right to a dignified death regulation.
THE CURRENT STATE OF BIOETHICS EDUCATION
IN THE SYSTEM OF MEDICAL EDUCATION IN THE
CIS MEMBER‐COUNTRIES REPRODUCTIVE RIGHTS, POVERTY AND DEVELOPMENT

G.L. Mikirtichian1, A.E. Nikitina1, L.A. Pinchenkova3, O.I. Kubar2 Martha Miranda
1
Saint‐Petersburg State Paediatric Medical Academy, Russia University of La Sabana, Colombia
2
Saint‐Petersburg Pasteur Institute, Russia miranda.martha73@gmail.com
3
Inter‐Parliamentary Assembly of the CIS, Russia

Reproductive rights have been considered as the cornerstone of
The higher medical education in all the CIS countries aims at development, promoting gender equality, improving
achieving three inter‐related and inter‐determined goals: firstly, reproductive health, making motherhood safer, preventing
to provide graduates with updated knowledge and skills on HIV/AIDS, but also for fighting poverty especially in the less
fundamental branches of medicine; secondly, to develop the developed countries, in particular those of the Sub‐Saharan
ability for self‐education, their pursuit of new knowledge and Africa and Latin America. It has also been considered that
their self‐actualisation in the chosen profession, and thirdly, to reducing poverty lies in supporting reproductive health, because
create conditions for the development of a motivated, dedicated the problems in this area undermine the productivity of
and moral personality of a physician. Particularly important individuals, especially women, and push families into poverty.
aspects of medical education are including principles of respect However, is the lack of reproductive health the real cause of
for human rights and basic freedoms as a principal moral poverty and less‐development? Controlling the number of people
component of medical profession. Inter‐relations of medicine through reproductive rights; is it a real solution to poverty? What
and education acquire a new meaning due to the emergence of are the outcomes of these policies so far? Are there significant
results in this area?
It seems that there is a doublespeak on reproductive rights. On caregivers. On the one hand we have the laudable extension of
one hand, they are shown as a benefit for less‐developed the life expectancy, while on the other we have the increase in
societies to overcome poverty, and on the other hand, they are the therapeutic efficacy of treating Diseases. Similarly there is the
considered as a very important outcome of the expression of issue of extending life in cases where the disease is no longer
liberty and women’s rights, especially in our contemporary days. curable nor containable, but progressive to an inevitable end.
But at this point, it is necessary to consider the ways in which Therein lies the issue, Axiologically speaking, of comparing the
population‐control programmes could violate basic human rights Value – both intrinsic and extrinsic, of the extension of such life
and can be a form of violence against women. and the quality of it. The ethical issues of Autonomy – of the
From the foregoing, the objective of this paper is to analyze patient and the caregivers, may be in conflict with the ethics of
whether the implementation of Reproductive rights is a the Medical personnel involved and assigned the task of
convenient way of fighting against poverty, taking into account providing such care. In addition for the physicians there are more
that there are other important aspects related to development complex bio medical ethics issues of Beneficence as well as Non
like; the need for children as a source of labour and security, high Maleficence which again need to be evaluated in terms of their
infant mortality, limited economic opportunity for the poor. In value for both sets of stakeholders.
addition, the role of equality and human rights in this aspect are This has led to the unique issue of “Therapeutic Obstinacy” a
being considered. complex phrase whose meaning can only be debated and
discussed on an individual case basis by the stakeholders but
needs to have some structured format and guidelines, as at times
THE CONTROVERSY OVER MEDICAL CANNABIS IN ISRAEL: it may result in achieving quite the opposite of what the basic
SCIENCE, ETHICS AND DEMOCRACY tenets of the Biomedical Ethics intends to achieve.
The other major paradox is that of euthanasia as it is viewed in
Daniel Mishori, Zach Klein the fraternity, whether it is a case of an act of Commission as in
Tel Aviv University, Israel Assisted Suicide or it is an act of omission of withholding Artificial
d.mishori@gmail.com Nutrition and Hydration (ANH) or providing Ventilator Support

for one who is in a Permanent Vegetative State (PVS). How does
Cannabis is regarded in Israel, as in many other countries, as a
one take cognizance of Advanced Directives, Living Wills and Do
dangerous illegal drug. However, a long struggle in recent years
Not Resuscitate in light of the moral theology and dictates of our
made cannabis a de‐facto medical drug (for pain relief, spasticity,
own religious beliefs and traditions, are questions that need
PTSD, or as an appetite stimulant for people undergoing
answers and that too quite clear and concise ones, so that the
chemotherapy) available only under severe restrictions, and only
basic rights of one created by God are not denied or violated by
after traditional treatments were practiced. Presently there are
us mortals.
about 17,000 patients using cannabis as medicine. A bill to legally
define cannabis as a medicine, submitted by MK Tamar Zandberg
in 2014, was rejected by the government. Thus, the state

CULTURALLY COMPETENT ETHICAL CARE AT THE END OF
simultaneously prohibits any use or possession of cannabis and
allowing the use of cannabis in (limited) medical contexts. LIFE: A HINDU PERSPECTIVE

This controversy is between supporters of expanding the use of Anu Kant Mital
medical cannabis and facilitating the process (no‐restrictions on Unit Head, UNESCO Chair (Haifa) International Network for
physicians to prescribe cannabis), and those who believe that this Biomedical Ethics, Western India
is a dangerous drug whose advocates seek to legalize through the akmital@gmail.com
medical system. Other parties involved in the debate include the
Ministry of Health, Ministry of Public Security, the Israel Anti‐ Knowledge of particular cultural requirements is especially
Drug Authority (IADA), physicians, patients, scientists, growers of important in times of transition such as at the end of life, where
cannabis for medical use, and pharmaceutical corporations. issues of death and dying require great sensitivity to cultural and
The background of this controversy is the debate whether the religious differences. Healthcare professionals need to
state should make cannabis illegal in the first place, and whether understand different cultures and deliver ethical care
the state should criminalize individual users. The current legal accordingly. This presentation explores the cultural aspects of
situation has enormous implications on research and on the end‐of‐life care among Hindus. The purpose of this paper is to
promotion of cannabis‐bases medical treatments and restricts investigate the experience of families of terminally ill Hindu
data collection. In this paper we will survey the parties involved patients. The presentation will then explore aspects of the Hindu
in this controversy and examine the different arguments and faith and their implications for doctors and nurses, specifically in
values involved, with special focus on the Israeli arena, on the the context of end‐of‐life care. It will outline the rituals and
background of massive changes that are now occurring in the ceremonies that help a Hindu have a good death and which have
field of medical cannabis and legalization of cannabis in different meaning for families and friends. Understanding of the Hindu
countries overseas. philosophy will encourage health care professionals to facilitate a
more ethically sympathetic environment for a dying person and
their family at the end of life.
ETHICAL ISSUES IN THE PROLONGATION OF LIFE IN THE
TERMINALLY ILL
BIOETHICS IN THE TRAINING AND MANAGEMENT OF
Anu Kant Mital SPORT
Unit Head, UNESCO Chair (Haifa) International Network for
Biomedical Ethics, Western India Iva Miteva
akmital@gmail.com Medical University of Sofia, Bulgaria
mitevai@ymail.com
The rapid progress in the fields of Medical Diagnostics and
Therapeutics has created conundrums of their own, for both, the Introduction. The policy of strengthening of quality physical
Medical fraternity as well as the Users i.e. the Patients and their education and sport needs an appraisal of approaches to manage
the challenges in sports medicine. Therefore, the aim of our ETHICAL DILEMMAS IN THE "PROTECTIVE EDGE"
study is examining the opportunities and problems presented by OPERATION
the increasing availability of technologies capable of enhancing
sporting performance and identifying the risks in sports for Uria Moran1, Yaron Tilinger2,3
1
creating educational and sports management practices to lead Israel Defense Forces, Israel
2
with justice, honesty, and beneficence. Maccabi Healthcare Services, Israel
Methods. A questionnaire is developed to consider the social 3 Israeli Physiotherapy Ethics Committee, Israel
determinants and risks of health aspects of sports and was self‐ uria.moran@gmail.com; Tilinger_Y@mac.org.il

completed by 300 professionals and 100 amateurs. Descriptive
The missile attack from the Gaza strip on the south and center of
and correlation analysis were used for data analysis.
Israel in July 2014 resulted in an intensive IDF ground assault on
Results. The study identifies health risks connected with the
several areas in Gaza strip to neutralize major firing zones and
intensive loading of locomotors system as well as poor working
offensive underground tunnels.
conditions which cause working trauma and diseases. It was
Thousands of regular and reserve forces took part in the
found that health culture among professionals and amateurs is
operation, their activity consisting of 2‐4 days on intensive
on a low level regarding the effects of performance‐enhancing
missions in alien area followed by several days of recovery in
drugs including anabolic steroids, stimulants, human growth
Israel. Prior to their entry, the forces were given a crash training
hormone and supplements. Because of an insufficient
course to prepare them best for the type of warfare there were
appreciation of the specific risks among the active engaged
likely to encounter.
professionals we intend to contribute in taking on this challenge
The forces were located in gathering grounds both prior to entry
to initiate a teaching module in the undergraduate program for
and following their exit. The intensiveness of the training and
students in different medical specialties.
battle, together with effects of exposure to the sun and humidity
Conclusion. There are arguments that sports medicine bridges
caused an accumulation of musculoskeletal and dermatological
the gap between science and practice in the development of
complaints among the soldiers.
principle‐centered leadership practices, and can serve as a good
The IDF Center for Medical Services responded by relocation
introduction to the many ethical dilemmas frequently arising
senior clinicians from central rehabilitation centers and clinics to
within the context of sport management. Strengthening the
the gathering grounds where the troops were located. These
quality of sport education will be achieved by addressing the
included teams consisting of an orthopaedic surgeon, a
study of sports ethics coupled with a study of management and
dermatologist two physiotherapists and support personnel, who
law.
set up field clinics providing advanced musculoskeletal and
dermatological services.
Due to the solidarity and patriotism, many civilians travelled to
CLINICAL COURSES IN OPEN DISTANCE LEARNING:
the gathering grounds to offer variety of services to the soldiers
IS IT ETHICALLY SOUND? off duty. Some civilian physiotherapist requested to volunteer to
CRITICAL CARE NURSING PERSPECTIVE assist the IDF Center for Medical Services teams, but legal issue

prevented drafting them. Some of these civilian physical
Maria Mabibiti Moleki
therapists decided to join other civilians offering services to the
University of South Africa, South Africa
off duty soldiers in the gathering grounds giving treatment in
molekmm@unisa.ac.za
parallel to the IDF teams.
Background: The practice of critical care nursing in open distance We present some of the ethical issues this situation creates,
learning (ODL) represents a complex domain of applied including documentation, follow‐up, the fact that soldiers are
knowledge that requires expert skills of decision making, clinical prohibited by order from receiving medical treatment not
problem solving, critical thinking and effective clinical reasoning. through the Medical Corps, and not less important the question
The foundation for acquiring these discipline related expertise is of how does the physical therapy profession want to label itself:
achieved through instruction, modelling and mutual problem as a professional clinical organization or as a nice to have service.
solving skills. Offering clinical courses through distance learning
education becomes a challenge for both the lecturer and the
student. COMMODIFICATION OF THE FEMALE BODY:
Aim: This article presents the experiences of critical care nursing AN ANTHROPOLOGICAL VIEW
students doing clinical courses in open distance learning.
Method: A qualitative phenomenological hermeneutic and Adi Moreno

contextual design. Purposive sampling was carried out with eight University of Manchester, UK
critical care nurses registered for this clinical course. Data was Adi.moreno@postgrad.manchester.ac.uk

collected through individual face to face in‐depth interviews. The
Contemporary neoliberal capitalism is characterized by the
interviews were recorded and analysed using basic elements of
sharpening of economic inequalities within states and between
Heidegger’s hermeneutic interpretive approach.
states, and in the expansion of market transactions into realms
Results The interpretation culminated in four relational themes
that were previously deemed private or intimate. In this
pertaining to the lecture, preceptor, the clinical settings and the
economic‐cultural climate, intimate exchanges (involving care,
preceptors. In this last theme two subcategories emerged (a)
relationships, sexuality, and reproductive capacities) have
absent and inconsistent relationship; and (b) relationship of
increasingly come to resemble other forms of utilitarian
compromise and favours.
transactions. It is precisely the extension of market logics to the
Conclusion: The study has a direct implication for the quality of
realm of the personal and intimate that brings about an
teaching and learning which translate to quality patient care. The
increased imaginability to the use of the body, sexuality and
challenges faced by the students registered in ODL were
intimacy as a resource for economic advancement.
highlighted. Recommendations for improvement and effective
Neoliberal practices of self‐commodification, instead of negating
supportive measures are also discussed.
the existence of a subject (as was the case in the slave trade) are
now based on the very existence of selves who actively 'choose'
to sell body parts, access to their bodies and different kinds of of respect for autonomy, non‐maleficence, beneficence and
emotional and intimate labour in the capitalist market. Thus justice.
subjugating themselves into regimes of control and harm. In this Objectives:
context, discourses of self‐authorship and freedom of choice • To explore and describe practical research situations in which
enable the masking of harsh realities of impoverishment, in subtle and even explicit transgressions of ethical principles
which bodies and bodily capabilities from the Global South serve present them self.
the needs and desires of the more affluent populations in the • To formulate guidelines to prevent and address such
Global North. transgressions
This paper is based on ethnographic accounts of women who Method: Both presenters are part of ethics committees and act
take part in certain bodily trades (namely sex‐workers and as assessors to proposals of research projects for which ethical
surrogates), and on public discourses that assess the legitimacy clearance is applied. The implications of some of the proposals
of these trades. By utilising these examples I explore the being presented for ethical clearance will be discussed.
importance of providing ethical frames that are context‐bound, Results: Ethical implications of examples of research conducted
and look beyond the individual 'informed consent' paradigm. will be discussed and include:
• Orphan‐headed households
• Healthy participant’s skin treated with laser to cause sores
ETHICAL AND SOCIO‐HISTORICAL CHALLENGES IN and then treated to heal.
PROVIDING HEALTH SERVICES TO INUIT CHILDREN AND • Chairperson of professional board conducting research in her
YOUTH: LESSONS FOR IMPLEMENTING HEALTH SERVICES profession and does not allow for anonymity
IN DEVELOPING REGIONS Conclusion: Researchers should guard against getting so involved
with practical research issues and the results their desire to
Michelle Mullen obtain that the participants and their needs are forgotten.
University of Ottawa, Children’s Hospital of Eastern Ontario, Researchers should always adhere to the principle that benefits
Canada should be greater than harm and that as little harm as possible
mmullen@cheo.on.ca should be caused by them.

Canadians wishing to travel to the developing world do not need
a passport. Despite its status as a G‐8 economy, there are

IMPLICATIONS OF UBIQUITOUS USE OF SMART
aboriginal communities whose living conditions fall far below the
national average. Fundamental services are critical challenges. In SPECTACLES OR DIGITAL EYEGLASSES

the extreme north, Nunavut was formed in 1999 and is one of SA Naimer
the most remote and sparsely populated regions on earth. The Ben Gurion University, Israel
Children’s Hospital of Eastern Ontario (CHEO) undertook to sodyna@clalit.org.il
deliver tertiary health services to the children and youth of the
region known as Baffin, or, Qikiqitani. The task proved far more Every truly disruptive technological advance leads to its own set
problematic than anticipated. Geographic, cultural and linguistic of ethics standards. Consider the prospects of the recently
distances generated poor understanding on both sides. Providing introduced digital eyeglasses into a socially accepted attire.
excellent tertiary health care into communities with only the Those caught "out" without metamorphosis into dressing with
most basic health services proved complex and frustrating. Some the smart spectacles may be viewed as backward and primitive
very medically fragile children required ongoing care of such as one that chooses not to carry a cellphone.
complexity that they were unable to return to their communities Such devices may hold honest and true benefits to both physician
of origin. Mindful of the historical context of disenfranchisement and patient. For instance, face recognition revealing identity,
of aboriginal persons and communities, a process has been items to be discussed at the visit, lists of medications, previous
undertaken toward improvement. Working with regional documents, tests required by consultants, previous visits,
partners, the program is being revitalized taking key values as medical literature, real time roll down of differential diagnoses,
pillars. First, that the program needs to be Northern led and medical agents and their doses, even documentation of parts or
supported by the South. Further, success relies on attention to the complete interaction, medical educational tool etc..
aboriginal voices, and the traditional knowledge, needs and Conversely, we are confronted with potential recording and
values of the communities served. Provision of excellent services documentation at all times which can lead to communication
along with the goals of reunification of children with family and obstacles and denial to bring up sensitive issues, fear of litigation,
repatriation to community are key. This paper examines the deceipt, distraction, privacy imposition etc... If socially acceptable
experiences and process of developing ethical health care by all, who may raise the legitimacy of demanding either side of
services in the context of postcolonial aboriginal experiences. the doctor‐ patient interaction to refrain from donning a
perfectly normative part of modern dress?
The purpose of this presentation is to raise the disputable issues
HOW ETHICAL ARE RESEARCHERS DURING THE of permanently carrying an audio‐video recorder with a screen in
PRACTICAL IMPLEMENTATION OF RESEARCH front of our faces with unlimited streaming information at all
PROCEDURES? times. With a specially orientated look at its influence on the
doctor – patient visit.
CPH Myburgh, M Poggenpoel A number of suggestions will be presented in order to accept the
University of Johannesburg, South Africa advantages of such utensils without creating superfluous
chrism@uj.ac.za & mariep@uj.ac.za imposition by its harmful repercussions.

Background: Empirical research always starts with an “idea”.
Usually this idea grows in the mind(s) of the researchers.
Enthusiasm takes over and the researchers often become
emotionally involved with the research idea. To guard against
ethical acting out, researchers should adhere to the cornerstones
CHILD MARRIAGE IN NIGERIA: agency is a part of quality assurance program. It makes sure that
A VIOLATION OF HUMAN RIGHTS licensed doctors are competent physicians. If any complaint
against licensed physician registered by public or reports from an
Awawu Grace Nmadu1, IA Joshua1, A Onyemocho2, insurance company or hospital, the investigation is conducted.
Z Muhammad‐Idris1, F Adiri1 An appropriate action is taken for licensees.
1
Kaduna State University, Nigeria Hospital based quality assurance program has been regularly
2
Benue State University, Nigeria conducted by the Join Commission for the Health Organization
jumainmadu@yahoo.com (JCHO). It is now known as the JC.

The JC developed the national reporting system that is identified
Child marriage is a global scourge that is practiced in many parts
as sentinel events. Last 10 years, the inspection and accreditation
of the world but remains prevalent in Africa, Latin America, the
program of the hospital is more focused to concentrate the
Caribbean and Southern Asia and predominantly affects girls. By
hospital where they need more assessment of system evaluation.
international conventions, 18 years has been established as
Which hospital will be inspected depends on the type of sentinel
the legal age of consent to marriage. In Nigeria, the practice of
event occurred and need for root cause analysis.
child marriage is deeply entrenched in tradition, culture and
The most recent health care legislation, Affordable Care Act
religion and is not uncommon to find girls below the age of 12
emphasizes in quality assurance and performance for payment.
years being betrothed to marriage, especially in the northern
Hospital Credentialing Program: In order to be admitted as
part of the country where many girls are given away to marriage
attending staff of the hospital, physician must go through the
without their consent and this denies the basic human rights of
credential process, and such privilege is renewable every two
these children, putting them in a disadvantaged position. Despite
years. Prior to any patient care, physician must be fully
the prohibition of child marriage in many international and
credentialed.
national laws, the current legal framework in Nigeria does not
Forensic Pathologist in QA Management: There is a need for the
support the implementation and enforcement of laws prohibiting
pathologist, especially for forensic pathologists working as a
child marriage. There is no definite age specified in the relevant
team with a quality assurance of health care system. Any death
enactments as the marriageable age for girls in Nigeria. Several
as results of old or recent injury must be processed with the
strategies are being adopted globally to address the
Medical Examiner’s or Coroner’s Office. Forensic pathologist
psychological, social, health and developmental problems posed
would be a desirable liaison person for the Trauma Center QA.
by child marriage. However, regional and local variations in its
occurrence necessitate adoption of global strategies in
combination with development of local initiatives to address it.

TEACHING BIOETHIC AT SAINT‐PETERSBURG STATE
This paper reviews the prevalence, causes and consequences of
child marriage in Nigeria, the status of implementation of existing MEDICAL PEDIATRIC UNIVERSITY

legislation and laws on early marriage in Nigeria and its O.K. Ochkur, M.M. Muratova, O.A. Jarman
implications on the rights of the girl child and proffers Saint‐Petersburg State Paediatric Medical University, Russia
recommendations on the way forward to promote and safeguard glm306@yandex.ru
the rights of the girl child.
Bioethics at SPbSPMU is taught since 1997. In the beginning this
course was meant for sixth‐year students. Currently, the program
nd
OVERVIEW OF THE US QUALITY ASSURANCE PROGRAM is extended to include students in the 2 year.
FOR HEALTH CARE The interdisciplinary course aims at facilitating comprehensive
understanding of moral challenges in modern medicine in the
Thomas Noguchi context of human rights and values, developing communication
University of Southern California Keck School of Medicine, USA skills consistent with fundamental principles of patient‐physician
noguchitt@aol.com relationship and acquainting students with national and

international documents on ethics and law regulating various
Recent Development in Quality Assurance: The most recent
aspects of medical practice.
development in the quality assurance and patient safety program
The profile and history of our University both imply a special
in a health care setting, 1) development of national reporting
attention to ethical issues in pediatrics: informed consent and
system based on the standardized sentinel event reporting. In
decision making; a right to life of embryo, fetus impaired
past, we have to try to improve the patient safety within the
newborns; rights of children born due to assisted reproductive
department or individual hospital, 2) Peer Review Organization is
technologies; ethical problems of prenatal diagnostics and
now well situated as a standard system for search of root cause,
genetic counseling; experiments involving children; child
3) Standardized the competency of all healthcare workers:
euthanasia, et al.
doctors, for all personnel working the patient care to be update
Students’ response reveals their involvement in the subject and
in knowledge and holds requires certificate or licenses.
motivation to learn more about practical aspects of applying
It is a life long learning is stressed.
principles and rules of bioethics in caring for patients as unique
The agency in charge of the graduate education, called the
individuals and addressing their biological, psychological, social
Accredited Council for Graduate Medical Education (ACGME)
and spiritual needs and values. Much interest is shown to the
formalizes the graduate medical training program. There has
development of therapeutic relationship with patients and their
been stressed that need for a life learning. Each physician must
families through efficient communication skills and emphatic
maintain a minimal education credit by the CME, but more
approach.
recently the SAM (Self Assessment Module) with short quiz is for
the specialty education. This specialty certificate must be
renewed every 10 years.

A role of licensing agency in quality assurance: Most healthcare
workers have license issued by the licensing board. The license is
renewed every two years. For renewing process, requirement of
minimal academic course in the field be taken. Medical licensing
ETHICAL ISSUES IN REHABILITATION MEDICINE ETHICAL ISSUES ARISING FROM A COMPARATIVE STUDY

OF PERFORMANCES IN TWO ENTRANCE EXAMINATIONS
Avi Ohry
FOR MEDICAL UNDERGRADUATE ADMISSION INTO A
Tel‐Aviv University & Reuth Medical Center, Israel
ori@reuth.org.il NIGERIAN UNIVERSITY

When dealing with ethical issues in today’s rehabilitation medicine Victoria Nanben Omole, MA Kana, IA Joshua, AG Nmadu,
(RM), one must keep in mind the significant particularities of this Z Muhammed‐Idris
branch of medicine: the multidisciplinary team work, the long and Kaduna State University, Nigeria
costly treatment as well as the absence of any immediate or nvable110@yahoo.com

dramatic cure. Our clients (patients) now have longer life Background: The Unified Tertiary Matriculation Examination
expectancy, and questions about the value of the quality of their (UTME) is a mandatory entrance examination for candidates
lives as well as about equal opportunities have become prominent, seeking admission into tertiary institutions in Nigeria (medical
while moral dilemmas have changed. At the same time, students inclusive) since 1978. An additional examination, the
contemporary medicine in general has acquired new post‐UTME was introduced in 2005 because UTMEs were
characteristics. The relevant concepts now are cost constraint, considered to be generally untidy, uncoordinated and sometimes
more science, evidence based on prospective double‐blind compromised. This study evaluated the performances of medical
controlled studies, and diagnosis‐related groups instead of fee‐for‐ undergraduates of Kaduna State University (KASU) in the 2
service. Hospitals have to function under the watchful eyes of (mandatory) entry examinations written in the same season and
society, the legal system, and the media. All efforts of the the ethical issues arising.
rehabilitation team are concentrated toward fighting physical Methodology: A comparative, cross‐sectional descriptive was
pathology, preventing disability, relieving pain and distress, and carried out on candidates of Medicine in KASU for the year 2012.
promoting a better life. However, since this is usually unrealistic, A total population study was conducted, with 653 candidates
RM tries to maintain residual functions and develop compensatory who had successfully scaled through the UTME (the first
ones to prevent secondary and tertiary complications of the examination) in the year 2012; 530 (ie, 81.16%) of whom sat for
existing disability and to restore the patient’s emotional well‐being. the post‐UTME (the second examination) internally‐conducted by
These aims are evidently subject to varying interpretations when the university.
translated into everyday action on the search for an optimal Results: The success rate among the candidates in post‐UTME
therapy. It is my belief that the patient should become an integral was only 12.83%; while the difference between the candidates’
part of the rehabilitation team. During the period of “parenting,” performance in both examinations was found to be statistically‐
patient autonomy is gradually restored. An atmosphere of mutual significant (p<0.05).
trust should be created, so that when the patients become a Conclusion: This calls for a closer review, scrutiny and screening
partner to their care providers, the ideal of common decision of the apparently “good grades” candidates applying for
making can be pursued. admission into institutions of higher learning parade or present.
Quality control and ethical issues should be at the fore in
considering the selection procedures & admission of
INTERDISCIPLINARITY: THE ROLE OF THE PSYCHOLOGIST students/candidates into medical schools and the medical
IN THE DOCTOR‐PATIENT RELATIONSHIP – profession in the long run.
INFORMATION AND DEMAND

Patricia Oliveira
IN THE WORST INTERESTS OF THE CHILD –
AASM, Argentina
USING NON‐VALIDATED PSYCHOLOGICAL TOOLS
lic_patricia_oliveira@yahoo.com.ar
IN CHILD CUSTODY DISPUTES
To report is to communicate, meet, learn, warn; but at the same
time, information is the patient’s right to full exercise freedom of Israel Oron (Ostre)
choice, becoming a prerequisite for the exercise of other rights, International Center for Health, Law and Ethics, University of
as the disposition of the body itself, the treatment, etc. Haifa, Israel
In the context of the doctor – patient relationship, the proper iOron@univ.haifa.co.il

handling of the information acquires a capital importance which In most legal systems there is a longstanding tradition that in
will result in the success or failure of that relationship, custody disputes during divorce proceedings, the court will order
stimulation or hindering the establishment of a therapeutic a psychological evaluation based on "the best interests of the
alliance between the doctor and his patient will ultimately child".
condition the development of the treatment. During a child custody evaluation psychologists use tests and
Ethics in medicine, as in "do things right", forces to consider that other assessment tools (i.e., observation of family interactions,
such straight, moral, legal conduct translates into "respect, interviews with parents and children). In this talk it will be argued
righteousness, responsibility and reciprocity". that these standard methods of evaluation are devoid of
Bioethics is understood in this context as a multidisciplinary methodological validity because they fail to measure what they
converge in which medical science and the Humanities such as purport to measure, which is parental fitness after a divorce. It
philosophy, anthropology, sociology, and law; understood as those will be shown that the tests and other assessment tools lack
disciplines that study man and his existence outside the biological criterion‐related validity. Namely, no predictive criterion has ever
field. In Bioethics the center of action is the downsizing of the axis been defined or employed to measure the effectiveness of the
of the medical activity: the relationship doctor ‐ patient. recommended custody arrangement (and the court's decision) in
The psychologist place in this process is the work with whatever either the short or long term.
information has been generated into the patient. The psychologist Moreover, psychologists involved in custody disputes tend to
will work with “what” and “how” the patients realize, with their disregard considerations that could broaden the scope of validity
fantasies, myths and theories underlying. Our intervention will help beyond its traditional technical questions, such as the possible
the patient to process the perceived information. negative side effects or unintended deleterious consequences for
each family member of using tests and other assessment tools. exposure to health hazards at the Ahmadu Bello University
However, neglecting these considerations by psychologists and Teaching Hospital, Zaria, Kaduna State.
courts is far removed from the best interests of the child, and in Method: This is a cross sectional descriptive study involving One
fact constitutes a detriment to his/her psychological hundred participants selected by systematic random sampling
development. technique from the ten admission wards of the ABUTH. The data
were analysed using the Statistical Package for Social Sciences
IBM 20 and STATA SE12.
DISEASE AWARENESS AND QUALITY OF HEALTH Results: The mean age of the respondents was 35 years. They
INFORMATION ON CLINICAL PROCEDURES: were mainly Hausa (58%) female (79%) Muslims (76%). Sexual
OBSERVATIONAL STUDY IN PATIENTS WITH harassment (13.3%), abusive insults from Health Care Workers,
(13.3%) and aggression from other patients were reported. Being
CANCER AND ALS
the sole care giver, type of illness, handling of patients blood and
Marcella Ottonello1, Ines Giorgi2, Debora Pain3, Anna Giardini4, faeces and length of hospital stay were significantly associated
Carlo Pasetti2 with exposure to hospital hazards. (p<0.05, X 2 >1, OR>1)
1
Salvatore Maugeri Foundation (IRCCS) – Scientific Institute of Conclusion: Abusive insults from Health workers, sexual
Nervi, Italy harassment and undue handling of patients’ specimen constitute
2
Salvatore Maugeri Foundation (IRCCS) – Scientific Institute of major ethical challenges in this setting.
Pavia, Italy Recommendations: The hospital should have a manual specifying
3
Salvatore Maugeri Foundation (IRCCS) – Scientific Institute of the roles and responsibilities of patients and their relatives. The
Milano, Italy Health Care workers need continued medical ethics education.
4
Salvatore Maugeri Foundation (IRCCS) – Scientific Institute of Safe accommodation is needed for patient relatives.
Montescano (PV), Italy
marcella.ottonello@fsm.it
SOCIAL ASPECTS OF END OF LIVE DECISIONS MADE IN
Introduction: Often a quality of health information incomplete
INDIA
and unclear causes the risk that Informed Consent can lose its
fundamental role to promote an active participation of patients Princy Louis Palatty
in decision‐making process. The aim of study was to observe India
possible differences between patients with cancer (in palliative drprincylouispalatty@gmail.com
care) and Amyotrophic Lateral Sclerosis (ALS) on the disease
awareness and on the knowledge of clinical procedures and new Society plays a watchful and subtle effect on decisions at end of
tools, such as Advance Directives. life. Common traditional practices are discarded for novel
Material and Methods: 53 subjects (30 with cancer and 23 with practices, which soon becomes way of life. It is advocated to
ALS) compiled the “Information about disease and therapeutic promote ethical practices by involving community at large.
decisions” Questionnaire. The 12‐items questionnaire aimed at Community end of life discussion. Many ethicists and scientists
getting patients’ opinion about their right to be informed and approve promotion of community end of life discussions. The
their consent to treatments. The answers to the questionnaire societal traditions, religious beliefs will lead to variations in the
were analyzed items by item and observed differences between interpretation of the end of life principle. This presentation will
groups (Fisher’s exact test). elucidate the factors relied on in making end of life decisions. It
Results: All patients have claimed the right to know their will conclude that the aim of humane supportive care at end of
diagnosis (83%) and prognosis (60%). Both groups declared to be life is achieved through ethical decision making. Often, it is the
aware of their disease (73%) and its evolution (66%). Differences joint decision of patient, physician and family. Establishing plans
have been found on opinions about the time dedicated from of care with patient and his kin, is a necessity. The decision
health care professions to the diagnosis and diseases information maker may be family, friend, physician and or the religious
(p=0.05). In addition, both groups showed not to know the person. It is not enough to prolong life, the quality should be
meaning of the terms “Invasive Therapy” (70%) and reckoned.
“Overtreatment” (85%). A significant difference (p=0.001) was
the preference of patients respect the type of Advance Directive.

Conclusions: The study shows that Health information appeared DETERMINANTS OF ‘END OF LIFE’ DECISION MAKING –
incomplete and unclear, with differences in function of diagnosis. A QUALITATIVE APPROACH (PATIENT/CAREGIVER
This causes a risk to lose the principle of autonomy and the PERSPECTIVE)
centrality of patients in decision making processes.
Princy Louis Palatty, Ashish Kumar, Prajwith, MS Baliga, Alvin Joggy
India
ETHICAL ISSUES IN KNOWLEDGE, PERCEPTIONS AND drprincylouispalatty@gmail.com

EXPOSURE TO HOSPITAL HAZARDS BY PATIENT Introduction: Despite scientific and technological advancements,
RELATIVES IN A TERTIARY INSTITUTION IN NORTH morbidity and quality of life remains unfavourable to medically
WESTERN NIGERIA futile patients. The aging slice of population is ever increasing,
even in developing countries like India, with the antecedent
Adegboyega Oyefabi1, Yahuza Basahua Sani2 burden on health. India is a country of rich cultural heritage and
1
Kaduna State University, Nigeria every Indian has deeply ingrained beliefs on aspects of life, death
2
Ahmadu Bello University, Nigeria and daily conduct. The ever‐changing cultural flux is evident
oyefabiadegboyega@yahoo.co.uk among differences in generations. Erosion of orthodox customs

Introduction: Patient relatives are significant part of the health has given way to a more accommodative, comfort zone. Looking
care team in any hospital setting. This study determines their through the Indian perspective would go a long way in
knowledge, perceptions and factors responsible for their understanding the dynamics in decisions at ‘end of life’
situations. Ethical dilemmas may be unravelled in conformity
with patients’ autonomy that often mirrors the prevailing value that agent or its products from an infected person, animal or
system in the region. Ethics have to be viewed mandatorily in the inanimate reservoir to a susceptible host; either directly or
Indian perspective. This study ventures into investigate on the indirectly through an intermediate plant or animal host, vector or
various cultural, religious and other predominances on ‘end of the inanimate environment. Than individual in the community
life’ issues. Ethical appropriation from presently available can be infectious people or infected people.
literature survey on this topic was undertaken by, this team of Strategies to do communicable disease control include:
researchers. Also the present needs and opinions on ‘end of life’ preventing infection through teaching and prophylaxis (including
issues by patients’ bystanders and HCP have been taken from a immunization), limiting the spread of infections by timely
random crossection of those attending a tertiary care centre. A investigation and follow‐up of modifiable communicable disease
qualitative approach was utilized to gain insight into the various incidents and putting protective measures in place, providing
reasons that actively determine their decision, by conducting in epidemiologic data for reporting and public health response
depth interviews. measures, continuous monitoring and surveillance of
Methodology: Design qualitative – subject selection: Exploratory communicable diseases in the community so they may be found
Method chosen: In depth interview and responded to before people get sick or there is a disease
Participants were randomly chosen from the pool of patients, outbreak.
patients’ relatives. The lists of probable participants were Human rights are rights inherent to all human beings, whatever
reviewed and at personal ease and convenience, interviews were our nationality, place of residence, sex, national or ethnic origin,
conducted color, religion, language, or any other status. We are all equally
Conclusion: The Indian patient is different, due to their inherent entitled to our human rights without discrimination. These rights
heritage and socio cultural dimensions. The decision making are all interrelated, interdependent and indivisible. Human
process, unraveled by this study, showed the parameters responsibilities are the universal responsibilities of human beings
influencing decision making to be – disease prognosis, regardless of jurisdiction or other factors, such as ethnicity,
functionality, comfort, social relationship, independence, type of nationality, religion, or sex. Social responsibility is an ethical
treatment care and availability / ability of caregivers. theory that an entity, be it an organization or individual, has an
The health care policy and legalization change the course of obligation to act to benefit society at large. Social responsibility is
decisions, the patient characteristics and physician influence also a duty every individual has to perform so as to maintain a
guide patient/ caregiver decision making at EOL. balance between the economy and the ecosystems.
This paper would like to describe the role of human right, human
responsibility and social responsibility in the communicable
PERSONAL INTEGRITY, INFORMED CONSENT AND diseases control. Every individual has human right, however
HUMAN TISSUES/ORGAN TRASPLANTATION AFTER every individual also has human responsibility and social
PETROVA VERSUS LITHUANIA: responsibility to control communicable diseases in the society.
CONSIDERATIONS FROM THE SPANISH LEGAL SYSTEM

María Magnolia Pardo‐López AN ITALIAN COURT RULING:
University of Murcia, Spain “AUTISM IS CAUSED BY MPR VACCINE”
magnolia@um.es
Alessandra Pentone, Liliana Innamorato, Francesco Introna
Under the guiding line of an overall review of the legal regulation “Aldo Moro” University of Bari, Italy
on transplantation of human organs and tissues currently effective alesspent@hotmail.com
in Spain and the European Community, a detailed study of the
different forms of informed consent that converge in cases of And the king said, “Divide the living child in two, and give half
human organs or tissues removal and transplantation is to the one and half to the other.” (1 Kings 3:16‐28)
performed, both in cases of deceased donors as well as living ones. There was a time when a king was the supreme judge who made
Taking as a starting point the complementarity between basic life and death decisions. He had the destiny of people in his
legal rules on informed consent and specific ones, both in hands, and was considered to be the source of absolute truth and
conjunction with advanced directives or living wills, we have to justice. Nowadays, after the evolution of democracy over the
distinguish between absolutely different situations millennia, judges are often the ones in society who are charged
(deceased/living donor; minor/adult donor). with making some of the most important decisions. In 1975, the
Regarding the figure of the deceased donor, it is of fundamental Daubert Standard established the universal guidelines for
importance to pay attention to the considerations made in JECHR admitting scientific expert testimony in court. In spite of this, in
of June 24, 2014 (case Petrova v Lithuania) close to the Spanish 2012, a judge in Italy accepted a medical expert’s opinion, which
Act on Organ Transplantation (1979). On the contrary, the figure was based on false and invalidated studies, declaring that “A
of the living donor and his informed consent places us in the child now suffers from autistic disorder with associated medium
context of autonomy of the patient. In addition, the very special cognitive delay due to, on well‐founded scientific probability, the
situation of the minors is analyzed. administration of the MPR vaccine”. Since its discovery, almost
70 years ago, the exact causes of autism are still unknown in the
scientific community. And so, on what foundation was “well‐
HUMAN RIGHT, HUMAN RESPONSIBILITY AND founded scientific probability” based in the blaming of autism on
the administration of the MPR vaccine? And what might be the
SOCIAL RESPONSIBILITY IN THE
consequences of this particular sentence on public opinion and
COMMUNICABLE DISEASE CONTROL

on public health safety? For example, one of the consequences of
Siti Pariani this sentence, and others like it, is that parents of children with a
Airlangga University, Indonesia wide range of pathologies try to connect these diseases to
parianisiti@yahoo.com; bioetik.fkua@gmail.com vaccines in order to obtain outstanding compensation for the
supposed harm done.
Communicable disease is an illness due to a specific infectious
agent or its toxic products that arises through transmission of
EPIGENETICS AND THE ASSISTED REPRODUCTIVE delivery system. These deficiencies show that in order to improve
TECHNOLOGIES the quality we need to ensure that care is safe, effective,
responsive to patients and equitable. A strong focus on quality
Irina Pollard improvement in health care by health professionals would
Macquarie University, Australia; UNESCO School of Ethics; Chair, further spur attentive observation, reflection, innovative
Australian Unit of the International Network of the UNESCO Chair thinking, and action in this area. Our analysis estimated that
in Bioethics (Haifa) bioethics is dedicated to improve education by building greater
irina.pollard@mq.edu.au awareness and understanding of the critical bioethical and social

dimensions of medical practice.
Parental health has direct impacts on the development of the
We aim to teach students about the pragmatic, medical and
offspring; but the means by which particular stresses impact on
social complexity of providing health care – not only how to treat
crucial health parameters across the generations are less well
and care for the patients, but how to educate them and address
understood. The hypothesis known as ‘developmental origins of
the systematic challenges of doing so in the context of a
health and disease’ postulates that certain epigenetic influences
country’s economic and health situation. Teachers of bioethics
(that is, all the external environmental variables which regulate
have to articulate their unique role and objectives so that they
gene activity) modulate normal developmental processes.
can establish adequate educational and training standards and
Developmental pathways in humans and other organisms are
programs. There is a need also to define core competencies in
generally buffered against epigenetic change; however, should
bioethics decision making in conformity with the professional
this protective buffer break down then development of certain
code of ethics.
tissues or organs may follow abnormal trajectories. That's why
We are actively looking for ways to build programs that are
attention is being directed toward children whose conception
respectful and offer basic values, standards of practice, and a
was medically assisted in the expectation of establishing whether
mechanism for accountability. Quality improvement is a worthy
certain developmental anomalies may be explained by epigenetic
goal and one that teachers of bioethics can contribute to,
mechanisms. Normal development may be disrupted by harmful
significantly and measurably. Teachers need to carry out that
epigenetic variables that a) disrupt DNA, forming deleterious
responsibility.
mutations, b) change gene imprinting processes and their
consequent expressions, and c) activate ‘fetal programming’
strategies that are triggered by unfavorable intrauterine

MORAL INJURY
conditions. Accordingly; stresses experienced at critical periods
of developmental plasticity may initiate increased risk of non‐ Mark F. Poster
communicable diseases in the future conceptus, neonate, infant Brockton VAMC, USA
and adult. Importantly, the health and living conditions of both mark.poster@va.gov
parents from the time of gamete formation to the conception of
the offspring are just as crucial as the mother’s situation during In his groundbreaking study Achilles in Vietnam, Jonathan Shay
pregnancy and lactation. Nevertheless, to beat infertility identified betrayal of themis, or “what’s right”, as the source of
increasing numbers of couples are seeking medical treatment lifelong moral injury. He was writing about combat trauma and
and, as familiarity with the available technology broadens, so comparing that described in Homer’s Iliad twenty‐seven
does its acceptance leading to further demands for new centuries ago with that experienced by US soldiers 45 years ago.
technological interventions. With increasing use of assisted The concept of moral injury applies to non‐combat traumas as
reproductive technology (ART), concern about likely long‐term well. It has broader clinical utility than a symptom complex such
health implications of ART is growing. Medically assisted as post‐traumatic stress disorder.
reproduction involves several steps that subject gametes and While moral injury is manifest in PTSD symptoms (e.g. intrusive
early developing embryos to environmental manipulations. thoughts, avoidance, numbing), it also is manifest in shame, guilt,
Consequently there is growing interest in investigating links demoralization, depression and suicidal behavior.
between these techniques and imprinting alterations associated Because moral injury has such broader manifestations and also
with ART manipulations. This presentation develops from a connects to intrapsychic and interpersonal and societal sources,
bioscience ethical standpoint focusing firstly on metabolic it has greater potential for research and treatment in each of
parameters that influence epigenetic characteristics and, those domains.
secondly, on the possibility of developing an effective This paper will explore the concept of moral injury in recent
international code of ethics that addresses the existing scientific literature and in case examples of US combat veterans.
unregulated global market of human embryo and stem cell
transfers, egg cell and sperm donation, and surrogate
arrangements. ETHICS OF CHRONIC PAIN CONTROL; A GREY AREA OF
DOCTORS’ POWER

TEACHERS OF BIOETHICS IN SEARCH OF NEW Andreas Prokopiou
St Georges Medical School at University of Nicosia, Cyprus
PERSPECTIVES
info@andreasprokopiou.com

Sashka Popova, Krasimira Markova, Kristina Popova
Medical knowledge and power have long been regarded as a
Medical University of Sofia, Bulgaria
defining feature of health care systems. It is acknowledged that
sashkapopova@yahoo.com
the increase in medical knowledge could result in an increase in
As the Bulgarian health care system undergoes fundamental power. It is also recognised that doctors’ have a prima facie duty
reforms during the last twenty five years, bioethics curricula in to relieve pain, which is more evident in those patients who are
medical training is becoming very beneficial to prepare students suffering from chronic pain.
from different medical specialties for practicing in the new From an ethical point of view, effective pain management is a
environment. Recent evidence from research suggests moral and professional imperative, as well as a personal
substantial deficiencies in the quality of public health care responsibility. Why it is believed that there are “grey” areas in
doctors’ power? In which ways can the medical power be PSYCHOLOGICAL ASPECTS OF MORAL DECISION:
misused? Are the patients and relatives aware of that power, and VIOLATIONS OF PROFESSIONAL DISCRETION IN FORMER
if so, in which levels they believe it can affect them? EAST GERMANY (DDR)
In this presentation, an attempt is made to identify possible ways
of misused medical power in doctors’ everyday practice. Andrea Quitz
Additionally, a proposal is presented with certain pre‐emptive Universitätsklinikum Erlangen and Friedrich‐Alexander‐University
actions, which may be applied to prevent abused authority from Erlangen‐Nuremberg, Germany
doctors over their patients. aaquitz@yahoo.de; andrea.quitz@uk‐erlangen.de
It is argued that regardless the size and specific area of the
problem, it is essential for the healthcare professionals to The Hippocratic Oath is used by physicians under both
examine their own use of power and to also continue their democratic and dictatorial circumstances and conditions. Even in
lifelong learning in medical ethics. Moreover, they have to former East Germany, physicians were bound to professional
remember that the care to the sufferers should be an act, where discretion. However, about 3 to 5 percent of the physicians were
professionals demonstrate factually their expression of love. working for the secret service and violated their patients’ right of
In conclusion, according to Plato, “science without virtue (areti) discretion.
and love can be unregulated, alienated and avail us nothing from The current study uses material from the former German
pursuing the good”. Democratic Republic (DDR) found in the documents from the
secret‐service archive (BStU) and publications on bioethics. Using
content analysis in ethical discourse or reports from the BStU, it
was possible to find declarations in motives and justifications
KNOWLEDGE AND ATTITUDES OF MEDICAL STUDENTS
which refer to the stages of Kohlberg’s theory. East German
CONCERNING OPIOPHOBIA – A CROSS SECTIONAL STUDY

socialist ideology refused universal ethical principles and named
Milica Prostran, Branislava Medic, Bojan Stopic, them as bourgeois and unprogressive. They held a view of a
Katarina Savic Vujovic, Danilo Obradovic, Sonja Vuckovic, “class‐bound” moral. The secret service (Stasi) preferred to not
Dragana Srebro, Radan Stojanovic employ principle‐oriented people and in most cases these people
University of Belgrade, Serbia consciously decided to work for the “Stasi,” even in case of
mprostran@doctor.com, prostranmv@med.bg.ac.rs physicians or medical ethicists. East German ethicists did not
argue with universal ethical principles and their own motives for
Opiophobia is an irrational fear of using or prescribing opioids. collaboration were mostly norm‐oriented. Through their ethical
Key barriers to prescribing opioids in physicians included discourses we can observe a strong relation between discourse
addiction potential, abuse or misuse, side effects and fear of level and moral behavior. But what was the official opinion about
review by professional bodies. The consequence is an inadequate the professional discretion and how did it occur in practice?
pain management. Which theoretical approach offers the most understanding to
We aimed to assess knowledge and attitudes of 3rd and 6th year moral psychology by explaining physicians’ or others’ behavior in
medical students towards the issue of opiophobia in our the case of moral dilemmas?
community. A self‐completed questionnaire was delivered to 361
out of 548 students of the 3rd year (65,87 %) and 307 out of 504
students of the 6th year (60,91 %). DISCLOSING INCIDENTAL FINDINGS IN PEDIATRICS:
Sixth year students estimated that they were more informed on HEALTH PROFESSIONAL PERCEPTIONS AND INSIGHT
the issue of opioid analgetics (3rd year median value ‐ 2,
interquartile range 2‐3; 6th year median value ‐ 3, interquartile Vasiliki Rahimzadeh1, Denise Avard1, Karine Sénécal1,
range 3‐4, scale 1‐5; P < 0,05). Most of students stated that they Bartha Maria Knoppers1, Daniel Sinnett2
1
do not know or not sure what a term “opiophobia” represents McGill University, Canada
2
(3rd year 67.86%, 6th year 55.92%). Although most of our University of Montreal, Canada
respondents believe that these drugs can relieve the strongest vasiliki.rahimzadeh@mail.mcgill.ca
pain, they point out that the risk of abuse of opioids is
conspicuous (3rd year median value ‐ 3, interquartile range 3‐4; Background: Progress in understanding childhood disease using

6th year 4, interquartile range 3‐4, P <0, 05). The final year next‐generation sequencing (NGS) portends vast improvements
students provided significantly more accurate answers in the nature and quality of patient care. However, ethical
concerning the effects of opioids (P <0.001). Also, students questions surrounding the disclosure of incidental findings (IFs)
estimate that patients are greatly feared of certain side effects of persist, as NGS and other novel genomic technologies become
opioids sucs as tolerance and respiratory depression (P> 0.05). the preferred tool for clinical genetic testing. Thus, the need for
The role of undergraduate medical education is essential in comprehensive management plans and multidisciplinary
providing good foundation for future doctors involved in this discussion on the return of IFs in pediatric research has never
issue, especially in order to be able to activate the ethical been more immediate.
principle of informed consent regarding these drugs. Therefore, it Objective: The aim of this study is to explore the views of
is necessary to improve knowledge and attitudes of our medical investigators concerning the return of IFs in the pediatric
students towards the issue of opiophobia. oncology research context.
Methods: We conducted a qualitative study with a purposeful
sample of 16 investigators in pediatric oncology from across
Canada. The study protocol and consent procedures were
reviewed and approved by the research ethics boards at McGill
University and the Sainte‐Justine Hospital University Health
Center (SJUHC).
Results: Our findings reveal at least four contextual themes
underlying the ethics of when, and how, IFs could be disclosed to
participants and their families: clinical significance of the result,
respect for individual, scope of professional responsibilities, and
implications for the healthcare/research system. Moreover, the bioenhancement enterprise on a voluntary basis, it can be
study proposes two action items toward anticipatory governance demonstrated that moral bioenhancement is moral.
of IF in genetic research with children.
Conclusion: The need to recognize the multiplicity of contextual
factors in determining IF disclosure practices, particularly as NGS TOWARDS A RATIONAL APPROACH TO THE ETHICS OF
increasingly becomes a centerpiece in genetic research broadly, PAIN
is heightened when children are involved. Sober thought should
be given to the possibility of discovering IF during the course of Z. Harry Rappaport
pediatric genetic research, and to proactive discussions about Rabin Medical Center, Tel‐Aviv University School of Medicine,
disclosure considering the realities of young participants, their Israel
families, and the investigators who recruit them. zvirappaport@gmail.com

Pain has variously been used as tool for punishment, testing
commitment, education, or social control, as a commodity for
PATIENTS’ PERCEIVED TO THEIR RIGHTS TO
sacrifice, or for sport and entertainment. Attitudes concerning
INFORMATION AND ITS IMPLEMENTATION IN these uses have undergone major changes in the modern era.
HEALTHCARE Our shared convictions on what is right and what is wrong are

generally attributed to religious tradition or to secular‐humanist
Ivan Rahmatullah, Sukmawati Basuki, Nancy Margarita Rehatta
reasoning. Here we elaborate the perspective that ethical choices
Universitas Airlangga, Indonesia
concerning pain have much earlier roots and are based on
ivan‐r@fk.unair.ac.id
instincts and brain‐seated empathetic responses. They are
Patients’ rights to information is one of the rights guaranteed fundamentally a function of brain circuitry shaped by processes
under the health act, medical practice act, hospital act, and of Darwinian evolution. Social convention, with its variability, is
consumer protection act in Indonesia. We intended to explore an overlay. The neurobiology of pain processing, including the
patients’ perceived to the right and its implementation in question of where in the brain the experience of pain is
healthcare, which focus on disease and prescribed medication generated, needs to have an effect on decision making,
knowledge. We are also interested in assessing the particularly in end‐of‐life situations. By separating innate
implementation of the right by asking whether the patients were biological reactions to pain and empathy to suffering in others
able to mention their disease and the prescription, and the from culturally imposed attitudes (memes) we may arrive at a
reasons if they were unable to mention them. Our study design is more reasoned approach to a morality of pain prevention.
a descriptive cross sectional study. We interviewed 309
respondents recruited from outpatient clinic at four community
health centers across Surabaya, Indonesia. Our respondents ETHICS AND PROFESSIONALISM: ONE AND THE SAME
consist of 100 male (32.4%), and 209 female (67.9%). Our results
showed that 96.5%, and 97.4% of them perceive that the Rebecca Reicher‐Atir1,2,3, Lihi Zur‐dovrat1,2, Nira Cohen‐Zubary1,2,
knowledge of the disease, and the prescription is importance. Sara Turkenich1,2, Boaz Tadmor1,2
1
Meanwhile, there are 65% and 47.9% of them able to mention Rabin Medical Center, Beilinson Hospital, Israel
2
the name of their disease and the prescription. The reasons of Tel Aviv University, Israel
3
their inability to mention the disease and the prescription are Academic Academy College of Tel Aviv Yaffo, Israel
mostly because of difficulties in pronouncing the disease and the rera@mta.ac.il; psycho@clalit.org.il

prescription (41.2% and 35.85%), and the doctors did not tell Moral distress and ethical erosion are major sources of work
them the disease and the prescription (31.78% and 34.59%). In dissatisfaction, burnout, and attrition in health professionals. We
conclusion, the awareness of patients’ right to information describe a one‐year workshop established at a tertiary medical
among the respondents, specifically to the disease and center to help minimize the risk of those among physiotherapists
prescribed medication knowledge, is high. However, we should and occupational therapists.
emphasize to the doctors and medical students to ensure their In the introductory session, participants were shown how the
patient understanding on provided medical information, which medical environment is a potential “hornet’s nest” of moral
plays important role in improving patients’ health outcomes. conflicts and ethical dilemmas. Emphasis was placed on keeping
ethical issues at the forefront of health care and the need to
resolve them on both the systemic and the individual level.
CAN MORAL BIOENHANCEMENT BE MORAL? During the course of the workshop, participants were asked to

describe events (prepared in advance) from their professional
Vojin Rakic
experience that had posed an ethical conflict for them. This was
University of Belgrade, CAEE Network of the UNESCO Chair in
followed by an open discussion on ways to cope with the
Bioethics, Serbian Unit of the UNESCO Chair in Bioethics, Serbia
problem, with adherence to professional ethical codes.
vojinrakic@hotmail.com
Issues of managing professional disagreements and tensions in
I will concur with various arguments against moral multidisciplinary medical staff; witnessing colleagues' ethical
bioenhancement, especially to its necessary implication of the misconducts; professional interventions under "Zuk Eitan"
state in a controversial moral perfectionism, arguing however atmosphere and dealing with political, gender, religious, and
that they apply only to compulsory moral bioenhancement. I will sectorial differences in patient‐therapist relationships were
show why these arguments do not prove that we should raised.
abandon moral bioenhancement altogether, as we have the Methods of evaluating the effectiveness of the workshop and its
possibility of voluntary moral bio‐enhancement. Voluntary moral conclusion will present.
bio‐enhancement can be shown to be preferable to the option of
no moral bioenhancement at all and to the option of compulsory
moral bioenhancement. If we embark on a moral
MEDICAL ETHICS AND GENOCIDE: boundaries to actualize this new paradigm in fertility. Four
TROUBLING UNMET CHALLENGES children were born by Biological Will™, and six will be born in
2015.
Elihu Richter1, Tamar PiIleggi2, Yoram Finkelstein3,
Peter Honeyman4
1

Hebrew University, Israel YOU KNOW IT IS TORTURE WHEN THERE IS OFFICIAL
2
Jerusalem Center for Genocide Prevention, Israel TERROR
3
Shaare Zedek Medical Center, Israel
4
Sydney University, Australia Barry Roth
elihudrichter@gmail.com Harvard Medical School, USA
broth@bidmc.harvard.edu
Since the beginning of the 20thcentury, the toll from genocidal
mass murder is estimated to be 180 to 250 million victims. In the The technical parameter to ask, “How did you survive?” during
Armenian Genocide and Holocaust, health professionals were forensic psychiatric assessment of torture survivors with
complicit directly as architects, planners, perpetrators, and Posttraumatic Stress Disorder led to a powerful heuristic. Torture
executioners, —or as bystanders. Doctors used Social Darwinism is a crime of specific intent; namely, an attempt to break non‐
and Eugenics to propagate “scientific” rationales for mass material human connections that sustained survivors. A priori,
murder, sterilizing, expulsions and other atrocities. these shared bonds of social contract are force we have to do
We ask: Do current ethical codes in public health and medicine right.
ensure that doctors and other medical professionals will not Ethics reveal our attitudes to the metaphysics of ontology
again be complicit in mass killings, –either as actors or bystanders (practice) and epistemology (validation of knowledge); ethics
The Nuremberg Trials of Nazi War Criminals led to the Code of eclipse the 4 dimensions of space and time. We always have
Helsinki, which requires informed consent for experiments in choice. The calls of the Prophets’ for social justice marked all
th
humans. But current ethical codes were not adequate for time; and revealed the 5 dimension of right and wrong.
deterring a psychiatrist from serving as a major architect in the Understanding that the criminal intent of torture aims to destroy
Bosnian genocide or deterring a doctor from ordering the use of civilized ties improves current torture definitions and
nerve gas agents in Syria. Nor did ethical codes deter public protocols.Forensic examination of PTSD in survivors’ shows that
health doctors from withholding treatment for HIV in infected official state torture and terrorism are synonymous in bio‐
populations (South Africa). Nor do doctors challenge the hijacking psychosocial and ethical dimensions.
of epidemiologic terms for dehumanizing a population —a Torture states and terrorists both use systematic means to instill
recognized early warning sign of genocidal intentions. terror‐‐‐overpowering fear to coerce and intimidate. Under the
We propose that doctors be equipped with an ethical code that color of authority, states use terror to torture; doing so, states
calls attention to their roles and responsibilities investigating, perform terrorist acts. Criminal acts of state performed under
reporting and interventions to protect populations subject to the color of authority derive from and display mental illness.
genocidal threats. This role includes a responsibility to identify Torture is not an aberration: we confront official terror in
the misuse of medical terminology as hate speech. “counterterrorism”, “war on terror”, surveillance, drones and kill
lists. Our shared project of culture and civilization also confronts
official propaganda, deception, misinformation and lies. Sane ties
THE BIOLOGICAL WILL™ – A PARADIGM IN FERTILITY of civil society oppose, resist, transform and supersede violent
intimidation and coercion of torture and terrorism.
Irit Rosenblum
New Family Organization, Israel
irit@newfamily.org.il; newfamily@newfamily.org.il ETHICAL DILEMMAS IN THE MANAGEMENT OF PAIN

Death is not necessarily the end of life. Children can be conceived Alan Rubinow
after the death of one or both parents. Posthumous paternity is Hadassah ‐ Hebrew University School of Medicine, Israel
possible when sperm from a deceased man is used to inseminate alanr43@live.com
a woman. Posthumous maternity is possible when a woman’s
ova are frozen and used to inseminate a surrogate. If embryos Pain and suffering are two distinct phenomena and the main
created by a couple during their lifetime are gestated by a reasons for which people turn to the medical establishment for
surrogate, a child can be born years after their parents’ death, assistance. It is universally accepted that it is the moral mandate
necessitating the legal system to determine the legal parents and of the physician and all those caring for the sick to alleviate pain
stakeholders rights. No nation has comprehensively regulated and suffering. Informed consent is the anchor, and ethical
posthumous reproduction, leaving posthumously‐conceived principle around which physicians and paramedical health
children without clear legal parentage or rights. providers apply their professional knowledge and skills in the
The Biological Will™ is a legal testament that documents the management of the sick. In the context of pain management
intended use or disposal of any individual’s sperm, ova or does the patient need to explicitly consent to have his/her pain
embryos in case of death, incapacitation or infertility. It offers an relieved or is it presumed that such consent is given in the very
alternative to anonymous sperm or ova donations by receiving act of seeking care? The balance of power in the management
gametes from a known donor. Everyone benefits: the donor pain is clearly in the hands of the caregiver and the patient, the
leaves descendants, the designated parent and donor’s family sufferer, is often the passive bystander and not proactive in
continue bloodlines, and the child gets a genetic record. demanding relief of his/her pain. Pain management on medical
In an age where a child can have multiple biological, legal and wards often lack the required sensitivity needed to understand
social parents, the Biological Will™ resolves questions of gamete that relief of pain goes beyond the treatment of any specific
ownership, donor consent, legal parentage, and children’s rights. medical condition and is the constant compelling duty of the
From my proposal to establish an IDF sperm bank in 2001 caregiver. Indeed it has been suggested that not providing
through birth of the world’s only child born of posthumous optimal pain is the equivalent of moral malpractice.
maternity in 2011, The Biological Will™ broke nature’s
WHAT SHOULD BE THE DESIRED MEDICAL EXPERTISE describes a study conducted in a private high school institution in
WHEN EVALUATING PLAINTIFF'S FUNCTIONAL DISABILITY the Philippines having an existing bioethics education program
AND NEEDS? integrated in the Biology subject. The goal was the evaluate and
elicit feedbacks from the students as they analyze a case study
Avi Rubinstein applying the Case‐Based Approach to Ethical Decision‐Making
DR.A.Rubinstein – S.Yakirevitch Law Office, Israel Model by Jonsen, Siegler, and Winslade (2006). The participants
yakiradv@netvision.net.il were grade 10 high school students enrolled in a semi‐honors
biology program. The participants were divided into groups. A
The legal meaning of the existence of opinions by doctors with case study lifted from UNSECO Casebook on Benefit and Harm
different specialties is that when the court is faced with two (2011) was given to each group for them to analyze applying the
opinions, it may give more weight to an opinion of a doctor who case‐based approach model. Findings indicated that the
is an expert in a certain area. integration of the case‐based approach model enhanced
This does not deal with the admissibility of the expert's students’ understanding and awareness of bioethical issues and
testimony, but with its weight in the courts eyes. When damages concerns. Furthermore, the participants were able to adopt a
of the crippled plaintiff are considered in the framework of the scheme that will allow them to analyze and evaluate bioethics
trial, the court will be guided by a basic principle in the law of cases leading to ethical decision‐making.
torts, which is the desire for restitution that is bringing the victim
(financially) to its situation before the trauma.
In this framework, when the court wants to determine the
FERTILITY POLICY IN ISRAEL: FROM EXEMPLARY LOCAL
plaintiff's disability and his (or her) needs, and their actual
PRACTICE TO A GLOBAL MODEL
translation into financial compensations, it would base itself on
an opinion and a testimony of an expert doctor. Etti Samama
In practice, opinion on functional disability and the evaluation of Israel
needs are given by experts in various medical fields, not etti.samama@moh.health.gov.il
necessarily by rehabilitation expert.
We already said – that the opinion – even though written by Israel is a leader in fertility treatments, offering greater public
neurosurgeon or an orthopedic surgeon – will be admissible. But funding of treatments than any other country, and enacting the
what should be the desired expertise of that doctor? Is it more first surrogacy law.
desirable, for the purpose of determining functional abilities, Nearly twenty years of experience in implementation of the law
ability to work or nursing needs ‐ that the doctor should be an enable us to discern the meaning of allowing surrogacy within a
orthopedic surgeon or a neurosurgeon, which have treated the state and between states.
plaintiff at the acute stage of his trauma or disease, or a Alongside the original intention of surrogacy as a solution for end
rehabilitation doctor? cases of infertility, a thriving industry of interested parties grew,
It is my view that it is more desirable that an expert on mostly economic, which markets surrogacy and as a result
rehabilitation – which has the professional ability to sum up the enhances the phenomenon.
entirety of medical disabilities will be the expert. He (or she) will The increase and commercialization are inversely proportional to
assist the court to evaluate the significance of the disabilities of the research findings collected, which point out the harmful
the patient's daily functioning, as well as the needs deriving from components of surrogacy, particularly the low success rates,
the medical and functional disability, and will be the expert process results, and the impact on the partners, especially the
helping the court to do justice and grant the disabled what they surrogate mother and her children.
deserve. We suggest then, that the court will do the right thing if The collected data shows the most difficult stages, which require
it gives the rehabilitation expert's opinion a greater weight – professional support, are fertility treatments, pregnancy and
since we believe that the opinion of experts who are not from post‐separation, and not necessarily signing the agreement and
the rehabilitation area can harm the crippled plaintiff mainly handing the baby over which are viewed by the policymakers as
because of lack of professionalism combined with the lack of the most difficult.
ability to foresee the future. The study shows that creating a respectful relationship between
At the same time, the rehabilitation expert has the ability to the parties, including with the baby, lessen the feelings of hurt,
provide the court with tools to evaluate the scope of additional objectification and exploitation.
treatment or additional needs in years to come. Surrogacy which crosses continents, cultures and languages
enhances the harmful components and removes the chance for
an interpersonal relationship and minimization of damage.
PROMOTING BIOETHICS IN THE HIGH SCHOOL LEVEL BY Abandoning the media arena into the hands of the mediation
INTEGRATING THE CASE‐BASED APPROACH TO ETHICAL agencies leads to publication of biased information, hiding the
difficulties and harm which leads to a dramatic increase in
DECISION‐MAKING MODEL
market volume.
Richard Deanne Sagun This study finds some positive clinical outcomes, yet we cannot
Ateneo de Manila University High School, Philippines help but be concerned by the implications that were brought into
rsagun@ateneo.edu, rdsagun@gmail.com light by this study.
Lessons can be learned from the Israeli surrogacy process and
Bioethics education is commonly observed in the medical and problematic points can be pointed out, even across continents, in
health field. Most case studies are geared towards analyzing order to minimize the damage to surrogates, especially of low
medical‐related situations that allow one to arrive at a decision socio‐economic class, while maintaining surrogacy as heroic and
that is ethically sound. However, the integration of bioethics unique.
education in the high school level is not commonly adopted and
observed. Article 23 of the Universal Declaration on Bioethics and
Human Rights (2005) emphasizes the need to foster bioethics
education and to disseminate information and knowledge about
bioethics at all levels, particularly to the young people. The paper
A PARENT OR A GAMETE DONOR? LEGAL CONSEQUENCES Talking about moral responsibility, the CBV hopes in a change of
OF AN UNSETTLED DEBATE pattern or mental approach and in the start of a cultural debate
on the origin of food.
Judit Sándor A careful attention in food purchasing and a consumer much
Central European University, Hungary more conscious of his/her own choices, could lead to the
sandorj@ceu.hu practical effect of engendering a virtuous circuit on the remote

actors eager not to disappoint who judges them.
Human rights often require reinterpretation on the cellular level.
This results particularly important in regard to the future risk of
Social movements for gender equality seem to have little impact
food shortage and the necessity of having to recourse to new
on the new biotechnological inventions. This explains why the
technologies of production.
legislation of the various countries consider egg donation as
It will be necessary to review concepts such as: price‐quality
being different from sperm donation, that surrogacy is forbidden
relationship, animal welfare, food and pathologies relationship,
in many places where egg donation is legal and that single
environment pollution.
women have to fight in a number of countries if they wish to use
reproductive services or if they want to have their egg frozen for
future reproduction. My objective is to investigate an issue that

CAPABILITIES APPROACH FOR MUTUAL FELLOWSHIP IN
the majority of legislators have so far neglected: what are the
consequences of the techno‐scientific approach for the COMMERCIAL SURROGACY

perceptions of fundamental rights? Sheela Saravanan
In June 2014, the European Court of Human Rights examined in Lichtenberg Kolleg; University Medical Center Goettingen,
two cases (Mennesson v. France and Labassee v. France) the Germany
recognition of the family status of children born as a result of vssarav@gmail.com, sheela.saravanan@zentr.uni‐goettingen.de
surrogacy agreements. In the first case, the French couple from
Toulouse had concluded a surrogacy agreement in Minnesota, India is growing to be a popular global destination for people
where the daughter named Juliette was born in 2001 after the seeking surrogacy services. This phenomenon has been
egg of an anonymous donor was fertilized with the father’s mushrooming in the backdrop of prevailing socio‐economic
sperm and the embryo was implanted in the surrogate mother’s issues such as; widening inequalities, slow increase in
uterus. The other French couple followed the same path in employment rate, stagnating poverty and increasing gender
California, where their twins were born. Upon their return to inequalities. Ineffective governance, unclear surrogacy
France, the Labassees encountered difficulties when trying to regulations that is inclined towards the medical private sector’s
obtain a birth certificate and citizenship for the child. The interests, unethical medical practices and increasing inflow of
applicants argued before the European Court of Human Rights couples from abroad seeking commercial surrogacy makes India
that failure to recognize their children’s status was in violation of an ideal environment for global injustice. Using
the Convention on the Rights of the Child and Article 8 of the ethnomethodology, this paper draws on Nussbaum’s ‘capabilities
European Convention for the Protection of Human Rights and approach’, to examine possibilities of global equality and mutual
Fundamental Freedoms and that it had already been raised in the fellowship in the practice of commercial surrogacy. The study
Genovese v. Malta case that citizenship was an integral part of reveals that surrogate mothers in India attempt at converting
personal identity. The court ruled that Article 8 was, indeed, their limited entitlements into capabilities by involving in
violated in both cases and concluded that the child’s origin is an exploitative surrogacy agreements. They need more protection
important element of privacy rights, which were damaged by the both for short term and long term issues related with surrogacy,
French authorities’ failure to recognize the child’s relationship life and medical insurance and psychological and legal support.
with the parents. The State holds the primary responsibility to promote capabilities
From recent legal cases in the field of assisted reproduction I will to enable people to enhance their entitlements and live a life
try to reconstruct the current problems of double terminology worthy of human dignity. Individuals need to assist the State in
and its legal consequences in the field of human rights. doing their duties by adhering to the justice and taxation system,
property rights with an aim to maximize collective welfare. The
medical practitioners and intended parents need to reflect on the
THE GUILTY INNOCENCE OF CONSUMERS exploitative dynamic of their involvement in this practice rather
than merely an economic/contractual perspective. At the global
Pasqualino Santori level, the practice of transnational commercial surrogacy in
Bioethical Committee for Veterinary Science, Italy developing countries calls for an international declaration of
p.santori@tiscali.it women’s and child rights in third party reproduction.

The Bioethical Committee for Veterinary Science (CBV) considers
dutiful to morally connect food to the destiny of millions of

farmers, of animals and of the environment. WHEN ONLY THE WEALTHY RECOVER: THE MEDICAL
Compared to other consumptions, food consumption has ETHICS OF ADDICTION TREATMENT AND RECOVERY

different characteristics since it is inevitable for survival and
Constance Scharff
because it is largely permeated with injustices among the
Cliffside Malibu, USA
complicated passages from production to use.
Constance@cliffsidemalibu.com
An urgent reason to acquire an active and critical attitude, in
regard to food, lies first in ethical responsibility and then on Addiction has historically been a disorder for which treatment
health reasons or on quality of food itself. was largely ineffective and the prognosis for recovery was poor,
The consumer citizen has not only the right to be informed but no matter a person’s economic resources or social status.
also the moral duty to search for information and the moral Twelve‐step programs, the time‐honored gold standard for
responsibility of the relapse of his/her choices on the life of the addiction treatment, are estimated to have a recovery rate of 5‐
weak and unknown part of the production chain. 10%. Long the best hope for addicts, the twelve‐steps are a
treatment modality that relies heavily on prayer and “miracles,”
not the stock‐in‐trade of medical professionals or typical homosexuality, etc. are signs of such self‐preservation behavior.

treatment for a medical disorder. Therefore, assessment and standards in modern bioethics cannot
Today there is hope for addicts. New, evidence‐based therapies be exactly the same for all countries and peoples; they must
have been developed that have much higher efficacy rates than correspond to ethnic age of this particular ethnic group.
in the past, some as high as 70%. Yet despite low efficacy rates, Therefore, scientific invariant of biomedical ethics always
those without resources continue to be sent to twelve‐step functionally acts as a cultural reflection of the national model of
recovery groups and many treatment centers use twelve‐step medicine. On the other hand, normative bioethical regulation
treatment to remain cost‐effective and maximize profits. allows adapting national standards for medicine as a cultural
Evidence‐based treatment programs are available almost complex to international requirements. Therefore, the
exclusively to those with significant financial means. These curriculum on bioethics should include three parts:
treatment programs are quietly being used by the wealthy to
secure their recovery from addiction. In the USA, even with the Theoretical Practical Applied bioethics
mental health parity act, most with fewer resources may not bioethics bioethics
know better quality care exists and have no access to it. Universal Knowledge Norms and Personal maxims
context and values patterns of of conduct,
This presentation will examine the changes in addiction
international approved by the
treatment; the gulf in access to quality addiction treatment bioethical society
between those with and without significant financial resources; regulation
and efforts to bring the most effective recovery resources to Confessional Religious Religious Correction of
those who need them, regardless of financial resources or global context traditions restrictions personal Maxim of
location. normative conduct religious
regulation in beliefs
Ethnic Cultural
medicine
Normative Implementation in
CONCERNS ABOUT WOMEN IN INTERNATIONAL CHILD context traditions of structure of the behavior of
PROTECTION CONVENTIONS the ethnic national health ethnic identity

group systems
Rhona Schuz
Sha'arei Mishpat Law School, Israel
rhona@mishpat.ac.il

ETHICAL CONSIDERATIONS IN LEGAL REPRESENTATION
The two major child protection conventions of the Hague OF PEOPLE UNDER GUARDIANSHIPS IN MEDICAL
Conference on Private International Law, the 1980 Convention on PROCEDURES
the Civil Aspects of International Child Abduction and the 1993
Convention on Protection of Children and Co‐operation in Meytal Segal‐Reich

Respect of Inter‐country Adoption, are widely considered to have Bar‐Ilan University and Ministry of Justice, Israel
enjoyed a good deal of success in promoting the welfare of meytalsr@gmail.com

children abducted or adopted from one country to another. Yet, Legal representation of people under guardianship has different
there is some evidence that these Conventions have not done ethical aspects. The basic assumption is that the person is well
sufficient to protect the interests of women and in some respects qualified to express will and has the legal capacity to do so.
have actually caused harm to women. Therefore, the representation is expected to be as with any other
This paper will examine the impact of the Hague Abduction and client. Still, the lawyer has to be aware of different situations,
Inter‐Country Adoption Conventions on women. It will then go on such as a cognitive impairment, that impose special
to consider similarities and differences between the abduction responsibilities.
and adoption contexts and that of inter‐country medically Medical procedures involving people under guardianship regard
assisted reproduction, in order to see in what ways the lessons delicate ethical considerations and involve special legal
that might be learned from the experience of the two Hague representation. Once the procedure requires a court order, the
child protection conventions are of relevance to a proposed patient is entitled to be represented. The lawyer's role in such
international convention to regulate inter‐country medically representation involves special skills and knowledge, cooperation
assisted reproduction. with professionals from different disciplines, such as medical
experts, social workers and others. The lawyer also has to
maneuver between his responsibilities to his client and the
ETHNIC BIOETHICS IN EDUCATION guardian who has a special legal status and is entitled to decide

for the client. High ethical standards will assure true
Natalia Sedova
representation of clients in these situations.
Volgograd Medical Scientific Centre, Russia
nns18@yandex.ru

Ethnic evolution is based on differentiation; social evolution is WILLINGNESS TO TREAT INFECTIOUS DISEASES:
based on integration. These two trends come into conflict now. COMPARING TWO DISTINCTIVE MEDICAL SCHOOLS
The ethnic groups that are losing their distinctive features resist
the tendency integration by all means. But technological and Avram Raphael Shack, Dan Zecharia Milikovsky,
economic needs, speaking in political form, suppress ethnic Renana Ben‐Yona, Dikla Akselrod, Alan Jotkowitz, Shimon Glick
uniqueness. The disappearance of ethnic division leads to a loss Ben Gurion University of the Negev, Israel
of genetic diversity. One of the tasks of bioethics is to save them. shacka@post.bgu.ac.il

Self‐protective behavior ethnos is a natural process. Ethnic
Introduction: Outbreaks of serious communicable infectious
extinction feels some discomfort in different areas, taken private
diseases remain a major global medical problem and force
measures to eliminate it. And there are already modifications
healthcare workers to make hard choices with limited
ethical standards and legislative change. Liberal‐moral issues of
information, resources and time. While information regarding
cloning, euthanasia, surrogate motherhood/ fatherhood,
physicians’ opinions about such dilemmas is available, research irrational decisions should query the mental competence
discussing students’ opinions is more limited. patients in critical medical condition possess.
Methods: Medical students from two programs at BGU were Three cases illustrate a spectrum of patients in life‐threatening
surveyed — an Israeli 6‐year MD, and a global health‐focused 4‐ condition who conscientiously reject lifesaving treatment
year MD for international students (MSIH) — and their responses knowing the fatal consequences: 1) Young adult who refused a
were compared. simple lifesaving surgery to repair stabbed cardiac injury. 2)
Results: Compared to their counterparts, MSIH students are Elderly person who consciously declined a lifesaving urgent
more likely to strongly agree to perform several procedures as a operation for abdominal aneurysm. 3) Middle aged person who
doctor (medical history [94.3% vs. 82.9%, p=0.02], draw blood suffered a brain stroke but refuse lifesaving treatment.
[83.7% vs. 76.5%, p=0.02], participate in surgery [77.6% vs. Any patient's request should be legally respected unless his
67.5%, p=0.093]). In preclinical years, they are less likely to agree mental capacity to analyze the consequences of his grave
to participate in surgery as a student [40.4% vs. 63.6%, p=0.011] decision is inadequate. Although the legal competence to make a
or treat a patient with swine flu as a student [68.1% vs. 90.3%, decision is dichotomized (yes or no), the level of mental capacity
p=0.001]. In clinical years, they are more likely to agree as a to make the same decision is commensurate with the severity of
student to participate in surgery [61.0% vs. 24.5%, p=0.020], the situation, thus grave medical decision requires the greatest
draw blood [83.3% vs. 69.8%, p=0.097]), and to treat a patient level.
with tuberculosis [83.3 vs. 66.0%, p=0.043] or SARS [76.2% vs. While physicians are constrained to the principle of beneficence
50.9%, p=0.034]. Overall they are less likely to agree that by (prevent harm, protect patient's autonomy, promote good), the
deciding to enter medical school they are morally obligated to patient is supposed to act along with his best interest. When the
treat any patient [65% vs. 74%, p=0.032]. patient's decision evidently opposes his wellbeing it is imperative
Discussion: MSIH students are more likely to agree to participate to assess the essence of his decision, to consider hidden external
in the care of patients with serious communicable diseases influence and to evaluate his mental capacity that may lead to an
despite being less likely to agree that they are morally obligated unreasonable behaviour in an urgent situation.
to do so. It is the society duty to protect its member from being the victim
of his fatal decision.

ETHICS AND REGULATION OF INTER‐COUNTRY
MEDICALLY ASSISTED REPRODUCTION (ERIMAR) – UNDER THE REGULATION RADAR: STRATEGIES AND
A CALL FOR ACTION TACTICS OF PHARMACEUTICAL COMPANIES TO
PROMOTE DRUGS AND MEDICAL PRODUCTS IN ISRAEL
Carmel Shalev
Haifa University, Israel Yaffa Shir‐Raz
cshalev@012.net.il University of Haifa, Israel
yaffas@netvision.net.il
In recent years there has been a rapid growth of medically
assisted reproduction (MAR), as well as an unregulated global The pharmaceutical industry is a major player with powerful
market of medical tourism for repro‐genetic purposes, due to political and economic interests, who attempts to influence the
variations in national regulation and global economic gaps. The media, the public, and policy health agendas.
emergence of a profitable market in practices of inter‐country This study assesses the pharmaceutical industry's influence
MAR (IMAR) involves transnational reproductive collaborations attempts process in Israel, and examines the strategies and
that have increased the risks of and actually incurred grave tactics used by companies to promote their products among the
violations of the human dignity and rights of women and public. Data generated by qualitative and quantitative content
children. A lack of professional self‐governance and the absence analysis of 1,465 press releases forwarded by PR consultants
of internationally accepted clinical‐ethical guidelines for MAR in representing pharmaceutical companies. In addition, 49 semi‐
inter‐country settings create conditions for potential structured interviews took place, with PR consultants and
reproductive abuse. In light of all this, there is an urgent need for executives of pharmaceutical companies; health journalists;
debate and action at international, national and professional hospitals and HMOs' speakers; and senior physicians. A case
levels so as to take all possible measures to respect, protect and study was also explored – the HPV Gardasil Vaccine, marketed in
fulfil the human rights of women and children involved in IMAR. Israel by MSD Pharmaceutical.
This paper describes an initiative of engaged academics in Israel – The study reveals how complex and sophisticated the corporate
the ERIMAR Project – to initiate a worldwide process of influence attempts process is, and indicates that many of the
deliberation on the complexities of IMAR, that will lead strategies and tactics used extensively by pharmaceutical
eventually to the adoption of an international code of ethics and companies and their PR consultants are those defined by scholars
an international human rights convention on IMAR practices. as "disease mongering", and some are very similar to those used
by the tobacco industry. In many cases, these strategies are not
only unethical, but also opposed to laws, rules and regulations in
DECREASED MENTAL CAPACITY JEOPARDIZES DECISION Israel.
MAKING PROCESS OF PATIENTS IN CRITICAL CONDITION As for the regulatory authorities in Israel, the findings indicate
that they do not constitute a damping force: a lack of supervision
Ehud Shalmon and enforcement, and vague and unclear regulations allow
Ono Academic College, Assaf Harofe Medical Center, Israel aggressive companies to use strategies and tactics that evade the
ehud.shalmon@gmail.com, eshalmon123@yahoo.com regulation radar, and which would never receive approval, even

in countries where DTCA is allowed.
The Lisbon Declaration on Patients' Rights protects the autonomy
of any person to consent or to reject the recommend treatment.
Occasionally patients in life‐threatening condition deliberately

make unreasonable decisions, which jeopardize their lives. These
THE MORALITY OF DEPORTATION OF SICK ILLEGAL research should be reasonable in the light of expected benefits to
IMMIGRANTS the individual and to the society.
Ethical issues discussed are: human cloning, In‐Vitro
Miriam I. Siebzehner1,2, Dorit Rubinstein1 Fertilization, Euthanasia, surrogacy, sex‐selective abortion, is it
1
Ministry of Health, Israel legalized? Does a fetus have rights? What about embryos? Etc.
2
Gertner Institute for Epidemiology and Health Policy Research, Should a mother be legally liable for drinking or taking drugs
Israel while pregnant? This of course would cause harm to their unborn
Miri.siebzehner@lbm.health.gov.il child? Should you be allowed to genetically modify your children

before they are born to prevent disease? What about to change
In recent decades efforts have been made by migrant workers
eye color make them taller, stronger, smarter, and better
from third world countries, to immigrate to developed countries
behaved? Should college students be forced to get the meningitis
in order to improve their wages and quality of life. This is often
vaccine?
done in contravention of immigration laws of the destination
Other Ethical Issues of concern are organ donation, face
country, especially when seeking a better life, such as infiltration
transplants, biopiracy, etc. Should people be allowed to sell their
made to the United States from Mexico. This phenomenon also
extra kidney or a portion of their liver to a person in need of a
exists in Israel.
transplant? This is currently illegal.
The possibility of sick illegal immigrant’s access to health care
Conclusion: Research Ethics should aim at good ethics in all
institutions in most European countries is limited to emergency
research projects. The task of true bioethics is to deepen and
situations. In the United States hospitals deal with the constant
propose the truth about humans, and to offer facts and
need to health expenditures, some are choosing "unlawful"
guidelines for action directed also to the ones who are
deportations of illegal patients in order to save money.
responsible for culture and common wellbeing of one & all.
Utilitarianism states that ‘the ends justify the means’ i.e. the
value of an action is determined by its contribution to overall
utility and happiness while minimizing the suffering. This doctrine

ETHICAL CONSIDERATIONS IN PEDIATRIC PHYSICAL
argues that actions are morally correct, as they tend to increase
happiness. This philosophy depends on consequentiality and is THERAPY

considered as a selfish approach as it doesn’t take into account Julie Smerling‐Kerem
any kind of suffering which the society may face due to a Alyn Hospital, Israel
particular action plan. In contrast, deontology is based on gkerem@alyn.org
fairness and social justice. The moral value of the action lies in
the act itself. There are things that are worth doing and there are While lifesaving medical procedures are now quite common
things that we will do and no matter what will be the outcome. place in neonatal and pediatric medicine, the effect of these
The presentation includes the arguments of the questions arise, procedures on the overall outcome of the child and his/her
the ethical approaches involved and conclusions regarding health family are less discussed in realm of medicine. The impact of
coverage for illegal immigrants. these interventions on the lives of these children and their
families are discussed in the realm of pediatric/developmental
rehabilitation. The physical therapist, who is one of the first allied
ETHICAL ISSUES IN MEDICAL FIELDS health professionals who meets these children and their families,
and often follows them for years at a time, is often caught
Rupa Rajbhandari Singh between conflicting issues while attempting to advocate for the
Head, Nepal Unit of UNESCO Chair in Bioethics, B.P. Koirala child and his family while understanding the medical background
Institute of Health Sciences, Nepal and the natural history of what is expected. This presentation will
profrupasingh13@gmail.com show the complicated relationships that the physical therapist

attempts to balance in the effort to represent the child his family
Ethics are norms of conduct that distinguish between acceptable
and the medical system.
& unacceptable behavior. Bioethics is a way of understanding
and examining what is “right” and what is “wrong” in biomedical
research and practice. It is the philosophical study of the ethical

controversies brought about by advances in biology and ETHICAL IMPLICATIONS OF MODIFICATION OF
medicine. Importance of ethics & bioethics was realized with the TRAUMATIC MEMORIES

study of McGill University & Tuskegee Study. The need for
Marcia Sokolowski
regulation and codes of behavior emerged from revelations of
Baycrest Health Sciences and University of Toronto, Canada
the research atrocities committed by the Nazis. Helsinki
msokolowski@baycrest.org; m.sokolowski@rogers.com
Declaration (1964) provides guidance in such areas as the use of
animals for research purposes. This case‐based presentation will begin more broadly with an
The Objective of this paper is to find out the ethical issues faced introduction to the definition of Neuroethics and its role in the
in medical fields including research & how to avoid these identification of ethical implications related to neuroscientific
unforeseen problems. advancements. The field of Neuroethics can be divided into two
Research ethics should aim at good ethics in everything we do. realms: the practical and the philosophical. The former has to do
Research often involves human beings, to whom duties are with the application of neursoscience and its likely consequences
owed, hence, it is necessary to formally scrutinise any study for persons and society; the latter is concerned with the ways in
projects & role of bioethics is important here. Ethical research which we think about ourselves as persons and moral beings. The
deliberately minimises the risk of harm, by thinking about importance of these two realms will be highlighted throughout
possible outcomes during research design. Principles of Research the presentation as I pose the question of how scientific
Ethics see to the Respect & Autonomy of participants involved & advances affect our understanding of moral responsibilities.
Protection of vulnerable persons. The research should generate While neuroscientific innovation is largely involved with
more good than harm & it should be justifiable & fair. Risk of development of techniques related to cognitive enhancement,
with a focus on memory enhancement, I will narrow my
presentation focus to the controversial topic of whether or not it Dignitas provides background information and examines whether
is ethical to tamper with traumatic memories. This question will there are other ways of tackling or minimizing the suicidal
be posed in the context of case review that centers on persons person’s suffering, including through access to palliative care.
diagnosed with Post Traumatic Stress Syndrome, such as soldiers However, when a person's wish to die is strong and firm, Dignitas
or Holocaust survivors, and where use of a beta blocker could be may locate a Swiss doctor who will issue the lethal barbiturate
potential useful in order to reduce the negative valence of their prescription following a screening process and some legal
memories. Ethical issues both pro and contra memory distortion examination.
will be identified. While research on the use of beta blockers in From legal and ethical perspectives there are few alternatives for
this context is currently ongoing, and holds promise that jurisdictions whose citizens are embarking on assisted suicide
modification of traumatized memories might be possible from a tourism. These include restricting particular benefits and services
neuroscientific point of view, it begs the question of whether or (Euthanasia) to residents and/or preventing residents from
not we should do it, from an ethical perspective. leaving to take up options available elsewhere; providing a
unified and harmonized moral stance with regard to ST; or
permitting ST under the assumption that ST can be justified by an
MORAL EXCLUSION: IMPLICATIONS FOR BIOETHICS appeal to the principle of interstate moral pluralism. Yet, the
choice between such alternatives derives from the moral
Daniela Sotirova justifications of the practice of suicide tourism that in themselves
Medical University of Sofia and Technical University of Sofia, are linked to the symbolic and emotional meanings that death
Bulgaria carries in each or every society. The article will analyze and
dasotirova@yahoo.com discuss these latter justifications and provide a prima facie

argument in support of the practice of ST.
Bioethics benefits from the concepts used in other appliеd ethics
such as organizational and business ethics. Among them is moral
exclusion – the process of setting psychological barriers of moral

space by the community. Usually these limits are connected with ENVIRONMENTAL REFUGEES – ELECTROHYPERSENSITIVES
ethical principles as fairnesse or universalism. It is argued that it (EHS) IN THE DIGITAL WORLD – A DISABLED POPULATION,
would be beneficial for the quality of decision making in DEPRIVED OF HOME, WORK & BASIC RIGHTS

bioethical groups of stakeholders to view actors’ positions
Yael Stein1, Mbong Eta Ngole2, Gaurav Aggarwal3,
through the lens of moral exclusion. The former is connected 4
Joel M. Moskowitz
with some soft ways of separation of individuals and groups 1
Hebrew University – Hadassah Medical Center, Israel
inside and outside, own and others. What constitutes such a 2
University of Yaounde, Cameroon
process from an ethical perspective, what are the behavioral 3
UNICEF, India
symptoms, are the questions to discuss. The concept of moral 4
University of California Berkeley, USA
exclusion in applied ethics was set for the first time in
yael.stein1@mail.huji.ac.il
environmental debates. It was also used in interpreting the
differences between patent and innovation in legal regulation of Hypersensitive reaction to electromagnetic fields (EMF) was known
biotechnology. as Microwave Disease, in radar and electrical workers in the 1940s.
At the level of behavior in a community the moral exclusion is an Today, ordinary people encounter electrohypersensitivity (EHS) to
aspect of the conflicts and their constructive solution. Then various forms of EMF, ranging from low EMF to microwave
moral stereotypes, labeling, prolonging, postponing, and radiation, also known as radiofrequency waves. As cities apply city‐
aggressive style of conflict resolution are emphasized. The wide Wi‐Fi and Wi‐Max, and schools expand Wi‐Fi to younger ages
pluralistic perspective (i.e. the recognition of legitimate – those with EHS are deprived of the basic human rights to
participation of various actors) counteracts the exclusion. Moral housing, work and public safety.
ехсlusion is a consequence of moral rationalization. Based on the When exposed to cellphones, routers, Wi‐Fi, cell towers, smart
study of literature and a comparison between decision making in meters, baby monitors or other cordless electronic devices, those
business organizations and ethics committees, the following signs with EHS experience diverse symptoms: physical pain including
of moral exclusion are defined: appling double standards; headaches, paraesthesia, cardiac irregularities, chest pressure,
dehumanizing – denying of one's rights; minimizing the potential impaired thinking, fidgetiness, skin rashes and sleep disturbance.
benefits of any interested party; normalizing imposed decisions Many are unable to work and must quit their jobs in order to
and aggressive style; de‐individualizing – neglecting individual save their health.
participation and its importance; blurring of responsibility – EHS is not psychosomatic. According to the World Health
denying personal responsibility under the pretext that it is Organization: “EHS is characterized by a variety of non‐specific
organizational. These procedures are often presented as quick, symptoms that differ from individual to individual. The symptoms
expert and managerial actions. Behind decisions that we usually are certainly real and can vary widely in their severity. Whatever
consider opaque, bureaucratic, hasty or biased lies the process of its cause, EHS can be a disabling problem for the affected
moral exclusion. individual.”
Electrohypersensitivity is estimated to be prevalent in at least 3%
of exposed population. Once developed, electrohypersensitivity
IN DEFENSE OF SUICIDE TOURISM (ST) symptoms can occur at much lower levels of exposure.

In most cities today, the electrohypersensitive cannot enter an
Daniel Sperling
airport, a hospital, a courthouse, banks, most workplaces,
The Hebrew University of Jerusalem, Israel
shopping malls, supermarkets. Electrohypersensitive children are
daniel.sperling@mail.huji.ac.il

forced to stop attending schools in which Wi‐Fi and wireless
Recent reports from across the world involve stories of citizens devices are employed or face disabling exposures that limit their
embarking on trips mainly to Switzerland and Mexico to be education due to induced serious health impairment.
assisted in their suicide by some other person/s. In Switzerland, This paper presents several sentinel clinical case reports of
for example, once contacted, a Swiss organisation named individuals with EHS, in order to stimulate public policy
discussion of the ethical rights of those with EHS, and to promote hand, the use of MRI for non‐hospital base research purposes has
additional clinical research into this growing problem. already become prevalent on university campuses in the USA.
Including: (1) Sweden (where electrohypersensitivity is an Several issues should be considered before decisions on this
officially recognized functional impairment / disability) ‐ a former matter are made. Does MRI protocol fall into the category of a
Chief Technology Officer of Nokia recently indicated that he “under minimal risk” procedure? Because the magnet of the MRI
developed EHS and the demyelinating disease Multiple Sclerosis scanner attracts certain metals to the instrument’s base, were
after years of EMF and RF exposures; (2) Canada ‐ a senior the subject lies, it could move loose metallic objects at high
commercial jet pilot forced to retire after developing EHS; (3) velocity in the MRI room. This might harm the subject. Individuals
Scotland – an experienced electrical engineer who became with pacemakers, heart rhythm disturbances, permanent
increasingly sensitive and unable to work with RF devices that he cosmetics (tattoo), or certain metallic implants could also be
helped to design. affected, as could those who suffer claustrophobia. Do we need a
These testimonies bring out symptoms and signs, early indicators physician in charge during the procedure? How we should handle
of EHS, that health care providers and employers should watch “Incidental” medical findings? Who is eligible to execute the
out for in patients and employees. research protocol and what form of qualification is needed?
These issues will be discussed.

UBUNTU: ALTERITY AS A PERSPECTIVE FOR PEACE
INSTITUTIONAL APPROACH OF AUTISTIC CHILDREN:
Flora Strozenberg, Edna Raquel Santos Hogemann,
A CONTRIBUTION FROM BIOETHICS & PSYCHOANALYSIS
Willis Santiago Guerra Filho, Luiz Otávio Ferreira Barreto Leite,
Milanna Nagib, Hellen Cristina Silva de Oliveira, Carlos Tewel
Ana Carolina Antão, Matheus Novais da Silva Red Iberoamericana de Ecobioética de la UNESCO, Argentina
Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Brazil carlostewel@hotmail.com
essenciais720@gmail.com
In the present paper we will broach different theoretical and
It looks for deepening the connections between peace, practical matters raised by the daily work in a Therapeutic
intercultural dialogue and communalism in the light of Ubuntu, Educational Centre (as of now, TEC), located in the city of Buenos
an ethical concept that emphasizes the alliances constructed Aires, where we work with seriously disturbed children and
between people and the relations established by them, and is young people, between the ages of 4 and 25 years old.
seen as fundamental to the African thought of the groups that The disturbances in the subjective constitution of these young
adopt Bantu languages. It develops an original exercise in people are displayed in breaks in the contact with the outside
diatopical hermeneutics – a methodology proposed by Raimon world: some don’t fix their gaze, others utter amorphous sounds,
Panikkar –, taking as the main goal to approach the Western others rock rhythmically, or walk continuously. The
ethical and political thinking to the epistemic and ontological manifestations are various, and so are the diagnoses: autism,
category of Ubuntu, recognized in the Zulu maxim umuntu psychosis, PDD, etc.
ngmuntu ngabantu (a person is a person through other persons). The work in the institution has a double objective: educational‐
It chooses as the basis of such study some contemporary thinkers pedagogical and clinical‐therapeutic. Both are carried out from a
as Lévinas, Bauman, Kunene and Nussbaum, who show a psychoanalytic approach which bears in mind the guidelines in
common concern with reverting a context of war and disregard Bioethics.
of the integrity of human beings, connected to an ethics of The relationship between psychoanalysis and institution, the
alterity, zealous of the values of conviviality and respect for the process of subjectivation in children, the modification aroused
cultural differences. It reveals the political dimension of Ubuntu from the work in the TEC, and the functioning of the institution
and the impacts of this conception on the process of facing the will be our axes of analysis.
problems of human rights in post Apartheid South Africa. We consider that the institutional work, together with each
Grounded on such transdisciplinary reflexion, it tries to point child’s family (through workshops for parents, individual
through a path to the implementation of policies for peace based interviews, movie workshops, etc.), is vital, given that the
on interculturality and communalism within different cultures. achievements of each of these children as regards their Self‐
reliance must be sustained by their cohabitation group. This way
we can boost what each of them can attain as achievements, not
THE USE OF FMRI FOR RESEARCH OUTSIDE THE HOSPITAL from an unshakeable and a priori objective, but from the
SETTING institutional focus, which poses a unique outlook, as well as a
special approach to listening.
Michael Tal
The Hebrew University of Jerusalem, Israel
talm@ekmd.huji.ac.il COMMUNICATING WITH SUFFERERS:

Magnetic resonance imaging (MRI) has become a common tool LESSONS FROM THE BOOK OF JOB

recently, including research on subjects not related to clinical
Joseph Tham
situations. In Israel there are two separate channels for reviewing
School of Bioethics, Italy and UNESCO Chair in Bioethics and
research protocols involving human subjects. There are: 1) A
Human Rights, Italy
clinical related channel with review and approve by a hospital IRB
jtham@legionaries.org
committee (named Helsinki), and 2) A non‐clinical channel with
approve by an academic ethics committee of university. Since the This presentation will look at the question of sin and disease in
MRI is a medical device and routinely employed in clinical bioethics with a spiritual‐theological analysis from the book of
practice, the issue of approving protocols involving its use Job. The biblical figure Job is an innocent and just man who
outside of a hospital, on a university campus in a non‐medical suffered horrendously. His dialogues with others—his wife, his
setting needs in depth consideration. On one hand, the proper friends, and God—can give many valuable insights for patients
use of a medical device in general is in a hospital; on the other who suffer and for those who interact with them. Family, friends,
physicians, nurses, chaplains, and pastoral workers can learn With the trade and tourism opportunities afforded by
from Job how to communicate properly with sufferers. The main globalization, people can take advantage of differences in
question for Job was how to maintain the tension between God’s regulation and values, and seek abroad goods and services, such
justice and God’s mercy and not yield to the temptation of as transplant organs and surrogate mothers, that are outlawed at
cursing God but to speak well of Him in moments of difficulties. home. Countries, too, use trade to violate their own rules.
England banned slavery but imported slave‐made goods from its
colonies. Countries that ban torture sometimes engage in
CONFLICT OF INTEREST BETWEEN THE INSTITUTIONAL “rendition,” relying on an “other” to commit the torture to
GOALS FOR THE ADVANCEMENT OF KNOWLEDGE AND extract the needed information.
INSTITUTIONAL ETHICS – ISSUES AND SOLUTIONS Effective regulation of most ethically fraught activities will
require universal adherence. However, because of people’s and
P. Thangaraju, D. Balakrishnan communities’ willingness to evade their own rules and the
UNESCO International Chair on Bioethics, SRM University, India availability of “others” to facilitate evasion, harmonization of
ptrajuagb@gmail.com, provc.medical@srmuniv.ac.in rules may be elusive.
When is harmonization desirable, and when is it not? Under what
Quest for knowledge requires experimentation. Clearly, the conditions does harmonization occur naturally? How might
Traditional ethical mechanisms do not measure up to emerging desirable harmonization be fostered? This paper suggests some
issues. Some researchers in their enthusiasm to gather answers to these questions.
knowledge overlook ethics. Certain others fall a prey to
indoctrination. A few knowingly trample on ethics.
There is a fine distinction between Research misconduct and
MIGRATION OF DOCTORS AND MULTICULTURALITY IN
Unethical research. Research misconduct pertains to fraudulent
THE GLOBAL CONTEXT
practices like intentional fabrication and commercial
considerations. On the contrary, the term ‘Unethical Research’ Elena Toader
indicates unethical practices e.g. disregard of non maleficence, Gr. T. Popa University of Medicine and Pharmacy, Romania
autonomy, consent, etc. It is this category, that requires our toader.elena@yahoo.com
attention. Solutions for this sorry state of affairs must fulfill two
criteria (i) They must be consistent and (ii) they must be realistic In the cultural intersection of globalization, the adjustment to the
and be applicable. new social and cultural context and the embracing of pluralism
We must mount a three pronged effort. I. General measures like are actions which converge towards the essence of the ethical
Public funding of Biomedical research, avoidance of commercial principles of autonomy and equity, and the considerations of
interests, Establishment of Trial Registries, strict adherence to justice on human rights.
publishing ethics etc. II. Incorporating Bioethics in the Medical Central ethical issue: the manner in which the migrating doctor
curriculum, right from the first day of medical education and, III. could maintain his or her own values but also develop authentic
Enforcement of the ethical canons, among the practising respect for a multitude of values, traditions and experiences
physicians and researchers. These efforts can be eminently produced by various professional and social circumstances.
implemented at the field level by the Project Evaluation Approach / methods / arguments: Primarily, we will extract the
Committee and the Institutional Review boards. These main ethical issues that the interconnection between
committees must include lay men, jurists and philosophers. globalization, migration of doctors and the multicultural context
Standard Operating Procedures must be scrupulously followed. involves in the medical field. We will show how these matters are
Further, it is imperative to endow these committees with reflected or not in the specific national context. In order to
adequate disciplinary powers. achieve a realist image of the local situation, we will analyze the
One aphorism of Hippocrates summarises all the above. Art is information obtained through participatory observations and
long, vitality is brief, occasion precipitous, experiment perilous, comprehensive interviews applied at two job fairs for doctors for
judgment difficult [Latin: Vita brevis, ars longa, occasion the representatives of the recruitment firms, doctors who
praeceps, experimentum periculosum, judicium difficile]. attended the fair and doctors who exerted or are exerting their
profession abroad. All the aspects regarding the empirical
investigation will be correlated with the debates in the literature
EVASION OF ONE’S OWN RULES: and the legal framework.
IMPLICATIONS FOR ETHICAL HARMONIZATION Conclusions: We will highlight the situations deemed as
representative for the manner in which the migrating doctors
Emanuel Thorne adjusts and integrates professionally in the cultural diversity. We
Brooklyn College of the City University of New York, USA will identify, present and motivate the aspects that determine
ethorne@brooklyn.cuny.edu the manner in which the migrating doctor relates to fundamental
values in the context of the meetings with the ethnocultural
People and countries resist ethical regulation. A common patient.
alternative to rejecting ethical regulation, or changing or
complying with it, is to evade it by obeying its letter while
eviscerating its spirit. It is this last response to ethical rules that
NEUROETHICS IN DRUG DEVELOPMENT
this paper investigates.
Consider: A Jewish couple in Bat Yam wished to neuter their cat. Zoran Todorović1,2, Dragana Protić1
Their rabbi told them that causing pain to an animal for their 1 University of Belgrade, Serbia
convenience was impermissible. What did they do? They sold the 2 Serbian Unit of the International Network of the UNESCO Chair
cat to a Muslim neighbor, who had it neutered and then sold it in Bioethics
back to them. This story crystallizes three insights: 1) people zoran.todorovic@mfub.bg.ac.rs, zoran.tdrvc@gmail.com
often choose to deal with their own rules by evading them; 2)
such evasion often requires an “other” who can supply the Neuroethics studies ethical, legal and social implications of
proscribed service; and 3) trade facilitates the evasion. scientific and technological advances in neurosciences on human
brain, cognition and behavior. In particular, it deals with human BIOETHICS APPROACH IN ENGINEERING FORMATION
health problems in neurology, psychiatry and other specialties;
function of ethics committees, government agencies and other Valeria Trigueiro Santos Adinolfi

bodies which consider the ethics of research in the field of São Paulo University and Paraiba Valley University, Brazil
neuroscience; work in pharmaceutical companies; care and vtrigueiro@yahoo.com, valeria‐trigueiro‐adinolfi@usp.br

treatment of vulnerable groups; work in non‐governmental
Engineering (in general, not just biomedical) affects life, health,
organizations (eg. patients' organizations) and others.
environment and society as much as biomedical fields, producing
Neuroethics arises from bioethics as a new field that provides
benefits and harms. It can increases mechanized food production
more deep insight into the brain structure and function, which
but also the rural exodus, fossil fuel dissemination impacts on
affect the fundamental issues such as free will and moral
morbidity and mortality because of pollution, f. ex. Engineering,
responsibility (eg. euthanasia, consent for organ donation, etc.).
as biomedical fields, uses technical knowledge to solve problems,
As regards drug development, neuroethics is involved in all
often heuristically, and make decisions in a scenario of
phases, from drug discovery and preclinical testing to clinical
uncertainty about all the benefits and harms of a project.
trials. In particular, neuroethics may be focused on animal
Engineers share responsibility about risks acceptance, and must
experimentation, translational pharmacology research, as well as
include moral values. Therefore, not all the risks on life,
clinical topics such as informed consent, research in vulnerable
environment and health value in an Engineering project can´t be
population, legal aspects in drug development etc. Ethical
described as mere calculus. This have been a frequent demand
aspects of the use of epigenetic drugs which affect brain
from some professors of Engineering in Brazil to us. However, it´s
structure and function may be of a particular importance.
no usual Engineering regular curricula have Bioethics in Brazil, or
even Engineering Ethics. Therefore, it´s necessary includes
bioethical approach since graduation training. It brings also the
MALPRACTICE IN REHABILITATION MEDICINE need of textbooks and materials, given Bioethics provides a

Iuly Treger viewpoint from the life and its values, health and environment
Ben‐Gurion University of the Negev and Soroka Medical Center, maintenance. In this paper, we investigates in literature (in
Israel Portuguese and English languages) Bioethics approach in
iulyt@clalit.org.il engineering textbooks. There is nothing in Portuguese language
literature, therefore in English often authors uses Beauchamp &
Malpractice issues are a concern for medical rehabilitation Childress principialism, Pellegrino Virtue´s Ethics and Potter.
specialists, but little information specific to the field is readily However, more discussions on Bioethics approach to Engineering
available. It was previously shown that the number of claims and risk assessment are needed, as much as specific materials to
brought was one‐third of that predicted relative to the size of the enrich Engineering formation and even Bioethics debate.
specialty. Dollar losses were found to be significantly lower than
expected compared with other specialties classified by insurance
carriers to be of similar risk such as neurology, pediatrics and DEVELOPING JOINT ETHICS REVIEW MECHANISM FOR
general/family practice and one specialty considered to be very MULTI‐CENTER CLINICAL TRIAL IN TAIWAN:
low, dermatology. EXPERIENCE AND REFLECTION FOR TWO YEAR RESULT
Injuries may occur in rehabilitation medicine field during doctors
or nurse's treatment and multidisciplinary team member's Daniel Fu‐Chang Tsai
therapy sessions for a variety of reasons, including: the improper National Taiwan University, Taiwan
diagnosis or medical treatment technique, therapist's fctsai@ntu.edu.tw
unfamiliarity with the patient, inadequate supervision, or broken
equipment. After horrifying abuses of research subjects during and after the
Rehabilitation treatment plan is based on maximizing function World War II being revealed, ethics review by Institutional
through the collective and coordinated implementation of Review Board (IRB) or Research Ethics Committee (REC) before
physical modalities, physical training with therapeutic exercise, human trials has been developed for protecting research subjects
medication, movement and activities modification, adaptive for four decades. To ensure the IRB/RECs are doing their job
equipment and assistive devices, orthotics, prosthetics, and properly, IRB/REC recognition or accreditation were also
experiential training approaches. Improper rehabilitation established for quality assurance for ethics review. However,
program or patient's placement in wrong professional facility can careful and lengthy review processes due conceptual
also be a reason of patient's physical, mental or psychological consideration, administrative or bureaucratic reasons were
harm. alleged to be procrastinating important and live‐saving clinical
To avoid a malpractice report few guidelines must be followed: 1. researches. This is especially serious in multi‐nations and multi‐
the patient, family members and support network must know all centers clinical trials since the same protocol may need to be
about the patient’s rehabilitation plan and expected optimal reviewed by dozens or even hundreds of different Hospital
timelines; 2. rehabilitation physician must document the IRB/RCs. How to form IRB/REC alliance or consortium to reduce
patient’s achievement of optimal recovery, requirements for repetitive processes and dis‐harmonization in review results and
ongoing therapy, treatment plan and the patient’s response to improve efficiency have become ethical issues as well as industry
rehabilitation and recovery; 3. written protocols and guidelines or academia survival issues.
must cover most of standard rehabilitation interventions; and 4. The speaker will in this talk share the process of developing the
for treatment involving durable medical equipment the medical joint Review Mechanism under National Research Program in
record documentation must include the precise descriptions and Bio‐Pharmaceutical, the NRPB‐IRB, and a government
technical protocols of equipment management. coordinated Central‐IRB which were developed in the past 3
years. The result shows the NRPB‐IRB and Central‐IRB have
effectively reduced the ethics review and approval time down to
less than 30 days, and prevented many repetitive administrative
and application processes. Ethics review can hence play its
proper role of human subject protection without delaying emended from the Chamber of Deputies on July 2011, is
research process. included.
The importance of the extended view of autonomy and of the
narrative approach of identity, which give the ethical validity of
YOUTH BIOETHICS PROJECT living wills and of advance directives of durable power of
attorney for health care affairs, will be highlighted.
Miroslava Vasinova, Alessandra Pentone The Italian Bill grants advance directives an advisory force, limits
European Centre for Bioethics and Quality of Life – UNESCO Chair their application over time and does not consider the validity of
in Bioethics Italian Unit oral declarations. The legal effects of this Bill will be studied in a
mvasinova@libero.it comparative approach, especially by taking into account the

French, German and English models. The French law also grants
Childhood is the ground on which we will walk for our whole life
an advisory legal force to advance directives, which are included
(Lya Luft)
in the Code de la Santé Publique (public law). Instead, in
We are pleased to present our ongoing pioneering project
Germany, where advance directives have legally‐binding force,
regarding bioethics for children and teen‐agers. This initiative
norms of advance directives are included in the Bürgerliches
came into being in Aosta Valley, Italy, in 2004 where the
Gesetzbuch (civil law). In England and Wales, the Mental Capacity
European Centre for Bioethics and Quality of Life – UNESCO Chair
Act introduces for the first time the lasting power of attorney,
in Bioethics Italian Unit began using some of the fundamental
substituting the endurable power of attorney dedicated only to
principles of bioethics (e.g. autonomy, mutual respect, do no
the management of propriety and finance.
harm, decision making, etc.), and applied them in an educational
To conclude, some ethical principles that the Italian Legislator
setting. Taking for granted that there is a seed of respect for
must take into consideration, are pointed out at. Further, some
human rights in every human being, our goal is to nourish it by
possible modifications of this Bill are suggested based on the
allowing the basic principles of bioethics to grow and flourish in
experience of other European Legislations.
all children. According to Patrick Estrade we believe that "the age
and nature of a person's earliest memory reveal the extent to
which he has been able to grasp and master the whole of his

life." Keeping this in mind, our aim is to develop strong LEADING THE CHANGE IN MEDICAL PRACTICE

“bioethical” roots in these “adults of the future” by thinking of Alexandrina Vodenicharova, Antonya Ianakieva,
them as “not a vase to be filled, but a fire to be lit” (Francois Vlayko Vodenicharov, Petar Chavdarovski
Rabelais). Medical University of Sofia, Bulgaria
cavdarovski@hotmail.com

WHO OWNS OUR DEAD BODIES? Context. Advances in medical technologies and knowledge have
made a positive impact on the quality and efficiency of medical
Renata Veselska practice but also created a complicated healthcare system and
Masaryk University, Czech Republic unanticipated ethical dilemmas. This complexity brings its own
veselska@sci.muni.cz set of risks no matter how dedicated and professional staffs are.

In this complex environment the leadership and management
This presentation brings an overview of the current practice,
both are essential to the success of any enterprise. The aim of
ethical aspects and legal framework of the use of human tissues
our study is to describe the involvement of medical professionals
taken from cadavers in the Czech Republic. Although the first
in leading the ongoing changes in medical practice as well as
specialized Transplantation Act based on the principle of
their knowledge and skills for these roles.
presumed consent entered into force in the country in 2002 and
Methods. A mixed methods approach was adopted combining a
this law is in accordance with the Oviedo Convention, the real
questionnaire survey of medical professionals and a review of the
situation is more complicated. In fact, additional new legislation
national and international literature on this matter. Respondents
concerning the use of human tissues and cells for applications in
identified a number of evolving challenges and contexts facing
human medicine allowed private companies to get control of all
them, including recent changes in the health care market,
commercial utilization of human tissues removed from cadavers.
payment arrangements, factors affecting quality of care.
Furthermore, the public awareness of this situation is minimal.
Results. Our study revealed that the majority of medical
All these aspects raise serious questions about correctness and
professionals are not prepared to become involved in leadership
justice of the principle of presumed consent if it is applied to the
roles ‐ roles that can lead and influence the future of our
use of human tissues for commerce purposes.
profession, and the future of health care in the country. They find
This study is supported by project CEB OPVK
it difficult to take appropriate action to raise and act on concerns
CZ.1.07/2.3.00/20.0183.
about patient care, dignity and safety. They lack an ability to
think creatively and adapt evidence‐based practices, and an
ability to contribute and work in a team.
ITALIAN REGULATION OF ADVANCE DIRECTIVES:
Conclusion. We conclude that a greater degree of
LEGAL COMPARISON WITH OTHER WESTERN professionalism needs to be brought to bear in the development
EUROPEAN COUNTRIES of medical professionals that will, whatever their role, take

appropriate action to lead effectively the changes in medical
Denard Veshi1, Gerald Neitzke2
1 practice. Quality improvement of care requires dealing with the
University of Bologna, Albania
2 new challenges understanding fundamental approaches to
Hannover Medical School, Germany
leading, motivating, and aligning medical professionals behind a
denard.veshi@studio.unibo.it
common vision or direction during the day‐to‐day practice of
In this presentation, Advance directives shall be analyzed through medicine, and to assist physicians in taking responsibility for
ethical and legal comparative approaches. A thorough health to individuals, the family, communities, and other entities.
examination of the latest version of the Italian Bill No. 2350,

ETHICAL DILEMMAS IN PHYSICIAN‐PATIENT CONCEPTS OF IDENTITY AND RELATED ETHICAL ISSUES
RELATIONSHIP IN MULTI‐CULTURAL SOCIETY IN THIRD‐PARTY ASSISTED REPRODUCTION

Rotem Waitzman Gabriele Werner‐Felmayer
Union Graduate College and Icahn School of Medicine at Mount Medical University Innsbruck, Austria
Sinai Hospital, USA gabriele.werner‐felmayer@i‐med.ac.at
rotemw1@gmail.com
The use of assisted reproductive technology (ART) is rapidly
Israel in a state with many cultures and all the time we have progressing. In high‐income countries, the rate of children born
more and more cultures that come to Israel. This situation can due to ART is up to 3%. During recent years, third‐party
cause conflicts between physician and patient. In the article I reproduction using donated egg or sperm cells without or with
looked on couple of cases in them, the culture can cause a surrogacy, often in a trans‐national setting, has become
conflict and I have suggested a way of communication that can increasingly practiced. There is a general consensus that
help to prevent conflicts between physician and patient that individuals involved as gamete donors or surrogates should
arise because of the culture different. remain anonymous (although this practice has been changed in
some countries) and by donating their “genetic material” or by
“renting” their body they resign from any role as parent of the
THE STUDY AND ANALYSIS OF CONFIDENTIALITY future child. The concept behind having one’s “own” child is the
IN THE FORENSIC IDENTIFICATION biological, i.e. genetic, link between parents and child. This is the
main reason to use ART in case of infertility. However, once a
Canping Wang, Zhen Li, Ruihong Zhang third party is involved the concept of one’s “own” child is
Kunming Medical University, China obviously no longer entirely a genetic one. There also can be
lizhenlaura@126.com different degrees of “own” depending on whether both gametes

are donated and if surrogacy is used. Another case is
Objective: We try to understand the relevant realization,
“mitochondrial donation” where only the enucleated donated
knowledge structure, attitude and behaviour, from those
egg cell and its healthy mitochondria are used but not the
policeman and policewoman who work in various public security
nuclear genome which stems from the future mother. Here, I will
bureaus(PSB) distributed in certain parts of Yunnan province in
analyze concepts of identity underlying these practices from
people republic of China about medical ethics in forensic fields.
scientific (biological) as well as from ethical perspectives. I argue
We also try to find out the way to prove the knowledge, concepts
that there is no consistency in how identity is defined in these
and behaviors about the forensic ethics.
various settings and that this is a major ethical issue in third‐
Method: Making the enquiring forms by our investigator; Carry
party reproduction as currently the relationship of the involved
out the investigation work in Puer, Xishuangbanna and Yuxi
three parties is inherently asymmetric.
states, which distribute the southern part of Yunnan province;
The way of investigation is Self‐Administered Questionnaire
Survey

THE EXPANDED AND EVOLVING ROLE OF THE ETHICS
Method: The content of the survey includes the principles of
informed consent, principles of confidentiality, the principles of COMMITTEE IN A PLANETREE PATIENT AND
respect and the principles of justice and equality. FAMILY‐CENTERED ENVIRONMENT

Results: Principles of confidentiality: for this principle the voice of
Bernard Paul White, Maria Hale, Members of the Northern
the people concludes that 73.9% of the people think that the
Westchester Hospital Ethics Committee
above principle is very important to be taken care of, whereas
Northern Westchester Hospital, USA
26.1% of the people had a very indifferent response to the above
bpaulwhite@gmail.com
ideology, and none of the people had a negative view to the
above stated idea. Whether the police share the case Planetree is a small but growing community of over 200
information of the investigation with the family, relatives and healthcare institutions in the United States and almost 70
friends of the deceased? For the above question the response of institutions throughout the world that is dedicated to patient
the people suggested that 52.2% do not get any information of centered care. As one of the first 5 Planetree Designated
the investigation, whereas 47.8% of the result suggested that Hospitals in the world, Northern Westchester Hospital has
people are provided with the appropriate information of the extensive experience in applying this patient and family centered
investigation. A survey was carried out which was to determine philosophy to all facets of the hospital experience. The role of our
that what percentage of the policemen use security protection in medical ethics committee has expanded far beyond clinical
there computer to make sure that their investigations are not consultations and the typical end‐of‐life issues addressed by
hacked. It was found out that 65.2% of the employees use most ethics committees. We participate in hospital financial
security protection whereas 34.8% of the employees were not decisions, care management decisions, community outreach,
taking the basic precautions. emotional and clinical support of the health care team, patient
Conclusion: After carrying out the above survey we can conclude care initiatives and practically every aspect of the hospital
that following the principles of confidentiality is one of the main environment. Our extremely broad‐based committee, which
criteria for the investigators. Whereas sharing the key consists of members of every level of the health care team as
information found out during the investigation with the family well as hospital administration and multiple community
and friends must be prohibited. And keeping security protection members gives us a wide ranging and, we feel, unique
in their computers is also very important to avoid any sort of perspective on all of these issues. We invite and welcome
leakage of the investigation is also a key aspect of the whole participation in all clinical and ethical discussions by the involved
procedure. patient and family members. We will discuss specific examples of
these activities and how they can be used to impact the entire
hospital environment including how to select and orient
community members to be active participants in ethical
discussions, how to create an environment that inspires candor
in expressing opinions regardless of clinical or ethical training and MOVING TOWARDS AN INTERNATIONAL CONVENTION
the significant role our ethics committee plays in supporting the ON SURROGACY AND ARTIFICIAL REPRODUCTION:
clinical providers of care, especially in times of crisis. IS IT TIME?

Debra Wilson
NEGOTIATING AWAY HEALTH? LEGAL AND ETHICAL University of Canterbury, New Zealand
IMPLICATIONS OF THE TRANS PACIFIC PARTNERSHIP Debra.wilson@canterbury.ac.nz

(TPP) AND THE TRANS ATLANTIC TRADE & While accurate statistics relating to the prevalence of
INVESTMENT PARTNERSHIP (TTIP) international surrogacy are difficult to obtain, some indication

may be found in the Australian government’s recent statement
Elizabeth Wiley1, Thorsten Hornung2, Deborah Vozzella Hall3,
that it is aware of 400‐500 such arrangements currently
Xaviour Walker4, Anya Gopfert5, Claudel Pétrin‐Desrosiers6,
operating between Australian citizens and Thai surrogates. In
Caline Mattar7, Will Perry8, Freya Langham9, Kostas Roditis10,
addition, further evidence can be found in the European
Gabriela Noles Cotito11, Maria Ignacia Alvarez Argaluza12,
13 14 15 16 Parliament’s labelling of surrogacy as a “global phenomenon”,
Ivana Di Salvo , Wunna Tun , Ian Pereira , Diogo Martins
1 and by the Hague Conference’s description of it as a “well
University of Maryland, USA
2 entrenched practice”.
University of Bonn, Germany
3 The legal issues surrounding surrogacy are numerous and
University of Connecticut School of Medicine, USA
4 complex, while the laws utilized to address these issues are often
Johns Hopkins Bloomberg School of Public Health, USA
5 general, vague, or out of date. In addition, laws relating to the
Newcastle University, UK
6 fundamental issue of the child’s parentage and citizenship can be
University of Montreal, Canada
7 inconsistent, resulting in the child being considered legally
Washington University in St. Louis, USA
8 stateless. While some legal issues are surrogacy‐specific, others
Nyes Institute, New Zealand
9 (for example the definition of a parent) are clearly of broader
Monash University, Australia
10 application to new and developing artificial reproductive
National Kapodistrian University of Athens, Greece
11 technologies. Addressing these issues now could minimize
Cayetano Heredia University, Peru
12 further issues later.
Universidad Católica del Norte, Chile
13 This paper will discuss some of the recent surrogacy stories to
University of Pavia, Italy
14 illustrate these emerging issues and the gaps in the law that have
University of Medicine – Yangon, Myanmar
15 often, by necessity, resulted in non‐legal and inconsistent
Queens University, Canada
16 solutions. Using New Zealand cases as examples, it will suggest
University of Beira Interior, Portugal
that given a clear indication that current domestic laws and
ewiley@gwmail.gwu.edu
guidelines are unable to appropriately address these issues, the
Over the last five years, a new generation of “mega” multilateral logical next step is not piecemeal and reactionary law reform, but
trade agreement negotiations has emerged. With a focus on a reconsideration of surrogacy laws in general. This can then
regulatory harmonization and reductions in non‐tariff trade provide the basis for the consideration of an international
barriers, the Trans Pacific Partnership (TPP) and the Transatlantic convention.
Trade & Investment Partnership (TTIP) aim to further trade
liberalization and boost economic growth. These agreements
seek to establish a new global framework for trade governance BEYOND MY BODY’S LIMITS: IMAGINATION IN SERVICE
and may have far‐reaching implications for the health and health OF CHILDREN WITH SEVERE MULTIPLE DISABILITIES
care landscape around the world.
TPP and TTIP negotiations are unprecedented in their size, scope Shifra Wohlgelernter, Orit Ben‐Yosef, Esther Jacobowsky,
and lack of transparency. With forty countries representing 65 Roni Eilati, Liraz Menasheoff, Molly Katzav, Maya Barghil
percent of the global GDP participating, the potential economic Alyn Hospital, Israel
power of these agreements is significant. On a truly global scale, shifraw@alyn.org

the TPP and TTIP could profoundly reshape health care and social
Background: Guided imagery is a widely applied method for
services, access to medicines and intellectual property,
stress reduction and pain control. Two groups of children (ages 4‐
communicable diseases, drug safety and research, prevention of
7 and ages 7‐16) with severe multiple disabilities were
noncommunicable diseases including tobacco and alcohol
introduced to imaginative ideas. The younger group experienced
control, environmental protection, food safety and supply,
guided imagery aimed at creating emotional regulation and
environmental/occupational health, medical education and the
positive sensations. The older group was involved in a
supply of health professionals.
multidisciplinary AAC (Augmentative and Alternative
In this context, this paper will first review states’ legal and ethical
Communication) ‐ based program aimed at enhancing self‐
obligations and authority to protect health and promote
identity by using guided imagery.
universal health coverage. We will then identify and analyze
Objective: We describe guided imagery used in two programs
potential legal and ethical implications of the TPP and TTIP on
within one special‐needs school, and ethical questions that arise:
health and health care. Potential strategies and
1. in the context of AAC, is the child truly expressing his/her
recommendations for ensuring that this next generation of trade
preferences, or is it merely a shadow of the adult's ideas?
agreements promote rather than undermine health will be
2. Is this intervention enlarging a gap between the child's
considered.
preferred reality (imagination) and actual reality? May this
buffer the child's motivation to achieve realistic, rehabilitative
goals?
Methods and results: Psychologist led a weekly group session in
collaboration with speech therapists and teachers. In the older
group, children created an imaginary personal “safe place” via
questions and answers on their AAC computers. In the younger
group, the children were invited to “go places” and “do things” as BIOETHICAL DILEMMAS IN ASSESSING CAUSALITY IN
they wished, in their imagination. PSYCHIATRY
Conclusion: This is a presentation of a novel combination of
interventions with a unique population: Imagination in the Samuel Wolfman
service of promoting psychological and social development in Haifa University, Israel
children with severe multiple disabilities. Ongoing doubts and s.wolfman@wolfman‐law.com

correspondence with bioethical experts regarding these
Causality is an indispensable term in many areas of the law, in
questions will be presented.
particular in tort law as well as in labor law.
When a plaintiff submits a negligence suit against a person who
allegedly neglected his duty against the damaged plaintiff, one of
THE ADOPTION OF BUDDHISM’S PRINCIPLES AS MEANS
the major issues to be proved to the court is the causality
OF IMPROVING PHYSICIANS’ WORK WITH TERMINALLY between the wrong doing and the damage. When the damage is
ILL PATIENTS bodily or mentally, the court has to rely on medical experts

opinions.
Ruth Wolf
It is more obvious when the damage is a physical one. Here the
Israel
expert can base his opinion on laboratory or imaging findings and
wolfru@walla.com
the questions can focus on the interpretations of such findings.
The medical approach as summarized by Leibowitz ‐ “We must When it is a mental damage, however, the medical expert, the
treat the person, not just the disease” ‐ highlights the importance psychiatrist cannot base his opinion on any objective data but his
of treating the sick person and not only the illness’ pathology. own impression from the verbal behavior of the patient.
This approach calls for healing not only the physical side, but also Same is true when the court has to assess causality in labor law,
‐ and mainly ‐ the mental aspect of the patient. One of the goals regarding the question whether a mental disease has been
of this article is to turn physicians' attention towards the caused by work stressors.
compassion necessary in treating a person with a severe or Another area related to labor law is the Israeli Statue for the
chronic illness, or a person who is dying – precisely because compensation of people hurt or becoming ill during service in the
sometimes there is no medical cure for the physical state of such armed forces.
a patient. Therefore, physicians’ attention does need to be In both areas the compensation of the disabled person is directly
directed to providing emotional assistance to such a patient. linked to the question of causality.
Sometimes, the emotional strength the patient draws from the Here too, the court has to rely on medical experts and in the case
medical team that is treating him can change his view of, and of a mental disease, on psychiatrists. The problematic issue is
approach to, the illness, and can enable his body to muster the that such an expert may have a predetermined agenda regarding
emotional strength necessary to deal with his situation. etiology and causality of mental diseases.
Buddhism’s approach enables the sick patient to experience his The presentation shall discuss the bioethical dilemmas of
illness in a different way, by making peace with one’s situation assessing causality in psychiatry and will argue that it is very easy
and, sometimes, even viewing the situation differently ‐ viewing to abuse the psychiatric "superiority" of the expert over the
the illness as a type of renewal. Buddhism, therefore, enables a Judge who may accept medical statements as absolute truth.
sick person to choose a different point of view when his energy is
exhausted and he loses hope, providing quality of life to patients.
In such a situation, a sick person finds emotional strength in the GOVERNANCE AND ETHICAL REGULATION OF HUMAN
knowledge that the end of his life is actually a renewal RESEARCH IN SUB‐SAHARAN AFRICA: A SYSTEMIC
somewhere else. REVIEW OF PUBLISHED STUDIES FROM 1980 TO 2014
The limited life expectancy of the terminally ill patient demands
that he be able to spend his time with minimal concerns and Muhammed Suraj Yusuf, Abubakar Kana Musa,
worries, and does not leave much time for treating the emotional Victoria Nanben Omole
side – the patient’s fear. In light of this fact, the patient’s ability Kaduna State University, Nigeria
to look ahead and grasp at hope is the most important issue. As Surajxq3@yahoo.com

much as possible, this is accomplished in an atmosphere of
Background: The establishment of good research governance
acceptance and with the absence, or reduction, of fear.
ensures integrity in research through accountability,
The freedom to decide for oneself how to behave, according to
transparency and responsibility. This systematic review aims at
one’s own approach, is what makes it possible for the sick
describing the evolution of the institutions of human research
individual to feel empowered, and is liable to encourage the
governance and ethical regulation in sub‐Saharan Africa.
patient to adopt a different point of view. The Buddhist approach
Method: PubMed was search from January 1980 up to November
recommends replacing the helplessness that usually accompanies
2014 to identify studies on human research governance and
the predicament of terminally ill patients with acceptance of
ethical regulation in sub‐Saharan Africa.
responsibility for their behavior in any given situation; this is
Result: We applied pre‐defined exclusion criteria to select 113
Buddhism’s main contribution to both physicians and patients
eligible studies from 146 studies. A progression in the number of
alike.
studies was observed over the past thirty‐four years: 1980‐1990
[2], 1991‐2000 [10], 2001‐2010 [62] and 2011‐Nov 2014 [39]. In
terms of geographical coverage the main countries represented
were South Africa [30], Nigeria [10], Kenya [6], Uganda [5],
Cameroon, Ghana, Malawi, Tanzania and Zimbabwe with 3
studies each. The studies were heterogeneous in terms of topic,
method and outcome: research ethics policies and oversight of
human research by governments [17], establishment,
certification, capacity building and functioning of governance and
ethics institutions of human research (including ethics committee
and clinical trial centers) [27], management of conflict of interest CASE STUDY AND PROBLEM BASE METHODOLOGY IN
in human research and ethical protection of participants and BIOETHICS EDUCATION
biological samples (e.g. biobanks) [40], and registration, ethical
approval process, conduct, reporting of research studies and Irine Zarnadze, Shalva Zarnadze, Levan Baramidze
trials [29]. Tbilisi State Medical University, Georgia
Conclusion: Over the past three decades sub‐Saharan African Irine.zarnadze@yahoo.com

countries have made uneven progress in setting up institutions,
Introduction: Case Study and EBM (Evidence‐Based
policies, processes and oversight of human research governance
Methodology) is a relatively new concept in education, but one
and ethical regulation. We hope this systematic review will
that is rapidly gaining acceptance as an important approach in
provide better understanding and specification of areas requiring
assisting students, residents, and practicing physicians with their
improvement for various countries.
clinical decision‐making.
Case Study and Problem base learning in Bioethical education has
become a widespread and effective method of using the
BIOETHICAL CONTROVERSIES – PERSONAL DIGNITY,
literature.
HOMO ECONOMICUS AND COMMERCIALIZATION OF Goals: Analysis of effectiveness of teaching methodology
BODY Methods: Observational Study

Results and Discussion: The skills to be mastered to use the EBM
Anastasia Zakariadze
approach include that of question formulation, literature
Ivane Javakhishvili Tbilisi State University, Georgia
searching, critical appraisal of articles, and application of
anastasia.zakariadze@tsu.ge, azakariadze@yahoo.com
evidence.
Bioethical controversies and dilemmas are reflections of The CS and PB component in TSMU has the aim of assisting
antagonistic correlations of postmodern society‐man as Homo students to learning objectives. Problems form the organising
Economicus and environmental world. Application of new focus and stimulus for learning, Problems are a vehicle for the
biotechnologies has an essential influence on formation of moral development of problem‐solving skills, New information is
consciousness, new values and evaluative criteria. As a result the acquired through self‐ directed learning, Learning is student
self‐identification of human being as spice is vanished; the centred, Learning occurs in small student groups, Teachers are
anthropological essence of man comes up the question. facilitators or guides
The issues of dignity of man and dignity of human life are very Problems form the organising focus and stimulus for learning.
crucial at that moment. These issues differ. The right of Role of the tutor: facilitator, help clarify discussion, suggest
somebody else’s’ intervention in human’s life‐esp.‐the ending of avenues of investigation, put problem in context of other
life, harvesting of organs from people who are in state of learning, suggest prioritising of learning issues, intervene in
irreversible coma, persons with disabilities, those‐who could not negative group dynamics, guide discussions about group process.
take responsibility for their life, etc. This would mean that Conclusion: Outcomes of CS and PBL are the Problem‐solving
different organs or tissues could be taken from the patient to skills, Self‐directed learning skill, Ability to find and use
benefit someone in need. Presumably, this would be done with appropriate resources, Critical thinking, Measurable knowledge
the permission of the so called donor’s relatives and possibly for base, Performance ability, Social and ethical skills, Self‐sufficient
a fee. Would such a revision of the law be ethical? and self‐motivated, Leadership skills, Ability to work on a team,
Analyzing bioethical controversies is difficult even if cases are Communication skills, Proactive thinking, Congruence with
relatively simply. Genesis of problematic situations is workplace skills.
characterized with several phases. Phase of contradiction is
followed by phases of conflict and critical phase.
We have a set of criteria to use, but for success we have to make DEVELOPMENT OF PATIENT RIGHTS AND HEALTH CARE
following steps: investigating the details of case, identifying the LEGISLATION POLICY IN GEORGIA
relevant criteria, determine possible courses of action and at last
to decide which action is most ethical. Presentation analyses Shalva Zarnadze, Irine Zarnadze
Georgian National Bioethical Committee’s work, their general Tbilisi State Medical University, Georgia
strategies to meet every day bioethical challenges. dato.zarnadze@yahoo.com

Introduction: Development of Patient Rights and Legislation

policy in Health Care is the base of Good service delivery and a
ISSUES IN PSYCHOLOGY, LAW AND ETHICS IN ISRAEL vital element of any health system. Service delivery is a

Moshe Zaki fundamental input to population health status, patient rights
University of Haifa, Israel among with other factors, including social determinants of
pr.m.zaki@gmail.com health. Implementation European standards and processes of
harmonization of Legislations now is the fundamental aim of our
The field of forensic psychology in Israel has matured Governance.
considerably in the past 11 years after the creation of the Aim: Analyses of Development Legislation processes in Health
Department of Psychology, Law and Ethics at the International Care, Patient Rights, Health Services Problem development for all
Center for Health, Law and Ethics at Haifa University (Israel), in social groups.
the beginning of the 2004. The progress has been achieved in the Methods and Materials: Statistical review, Governance reports,
academic level (instruction and research), as well as in applied Expert analyses‐more 60 experts‐respondents. Expert analyzes of
Forensic Psychology (assessment and treatment). development documents of Legislation of Health Care, medical
Today, forensic psychology is still coping with professional and services and Healthy Problems in Georgia.
ethical issues in forensic assessment and treatment as services Results: Survey was conducted to study Starting from 90‘th, the
delivery to the court, in civil as well as in criminal proceedings. Government of Georgia made several attempts to transform
Georgian health care system into one with improved efficiency,
accessibility, and quality services. The main principles of health
care reform since 2006 were to make the transition towards website supervised by the presenter dedicated to providing on‐
complete mercerization of the health sector: private provision, line advice on all topics related to taharat hamishpacha. This
private purchasing, liberal regulation and minimum supervision. database has undergone both quantitative and qualitative study
After 2013 in Georgia new regulations of Governance system of and the results of these analyzes will be presented. The ethical
Insurance. issues in the use of hormonal manipulation for religious needs
Conclusion: Governmental efforts in Development of legislation, will be discussed as well.
promotion and disease prevention can have significant impact on This presentation will allow practitioners to better understand
health status by preventing chronic diseases and detecting health the needs of couples who keep the laws of taharat hamishpacha
problems at a treatable stage. and address the overall topic of respecting the beliefs of those
receiving medical care.

DOES DIRECTING PATIENTS TO ADDITIONAL PRIVATE
PHYSICAL THERAPY CARE PROVOKE ETHICAL DILEMMAS? CROSS‐BORDER REPRODUCTIVE CARE: THE CASE OF
PRE‐IMPLANTATION GENETIC DIAGNOSIS (PGD)
Ilana Zilberstein
Ministry of Health; International Center for Health, Law and Shachar Zuckerman, Gheona Altarescu
Ethics, Israel Shaare Zedek Medical Center and Hebrew University – Hadassah
izilbe03@gmail.com Medical School, Israel
shacharz@ekmd.huji.ac.il
"Mr. Cohen is a post CVA patient in a rehabilitation center. He
receives daily Physical Therapy (PT) treatment by Eli, who also Cross‐border reproductive care (CBRC) is a growing
offered him additional private treatment on weekends.” phenomenon, mostly for surrogacy and gametes donations. Less
"Mrs. Green is being treated for a post whiplash injury in a public discussed issue is pre‐implantation genetic diagnosis (PGD)
clinic. She asked a private PT for parallel treatment in order to performed in foreign country, because of regulatory differences
speed up her rehabilitation. The private PT agreed.” between restrictive homes countries in which legislation strictly
“Mr. Dwyer is a nursing home resident. Following a thorough bans this procedure versus other permissive countries where it is
physical assessment his care plan calls for three treatments a common practice.
week. Being unhappy about too few treatments, his daughter One cause for CBRC when couples interested in PGD is the search
purchased additional treatments from an external PT.” for laboratories performing this technique for medical conditions
These are a few of many examples that raise ethical dilemmas, considered mild/non‐morally permitted in some countries, while
many of which are integrated with clinical considerations. For the same condition is considered severe enough to justify PGD in
example, when a PT offers or is asked to provide additional other countries. An example of this ethical controversy is
treatments, in parallel or in addition to ongoing care, in a public represent in a case of a British couple in which the female was
or a private facility of Physical Therapy service – does the patient affected with Gaucher disease and her spouse was a carrier for
really needs additional treatment?" the same disease. The couple had a 50% chance of an affected
This presentation’s objective is to elaborate on such dilemmas child and wished to perform PGD in order to prevent the disease
relating to therapist‐patient relationships, professionalism and in next generation. The couple applied in their country for PGD
collegiality. These ethical dilemmas and the clinical but was rejected since this condition was not considered severe
considerations involved means answers are not straight forward. enough to justify the procedure. Seeking other avenues to
It will be proposed that these dilemmas require specific perform PGD anyway, the couple reached Israel, in which
regulations and guide lines within different PT frameworks and performing PGD for Gaucher disease is both allowed and a
patient populations. This presentation will also offer methods to relatively common procedure.
hone clinical and ethical reasoning skills for each situation. These Ethic committees worldwide are involved in understanding which
ethical dilemmas are unique to the essence of our profession medical usage for PGD is justified and ethical. Gaps between
within the health system in Israel. different countries' regulation, growing demand and relative
ease of traveling abroad inevitably raises the question of how we
define severe condition and moreover who is best placed to
WHEN RELIGION AND MEDICINE INTERSECT: make decisions about these controversial questions and their
THE EXAMPLE OF TAHARAT HAMISHPACHA implications.

Deena R. Zimmerman
Jerusalem District Health Department; Nishmat – The Jeanie ETHICAL CONSIDERATIONS OF USING OFF LABEL MEDICAL
Schottenstein Center for Advance Torah; TEREM – Emergency TREATMENTS AND MEDICATIONS IN DISASTERS
Medical Services; Maccabi and Meuchedet Health Services, Israel
dz@terem.com Shlomit Zuckerman
Tel Aviv Yaffo Academic College School of Nursing, Israel
Patient centered care is currently considered an optimal Shlomit.zuckerman@gmail.com
paradigm of clinical practice. For adherents of a religiously
observant lifestyle, the dictates of one’s faith can have an Off‐label use of medications in the western world is widespread.
important impact on one’s medical needs. The goal of this oral For example, recent data shows that children receive 25‐31% off‐
presentation is to use the example of couples adhering to label products. Moreover, 70% of children and 90% of neonates
Orthodox Jewish practices as an illustration of this tenet. receive off‐label products. A report from 2003 found that highest
Specifically, it will describe the intersection taharat hamishpacha rates of off‐label use were anticonvulsants (74%), antipsychotics
(also known as hilchot niddah – Jewish religious rules relating to (60%) and antibiotics (41%). Off‐label use is also common for
the physical relation of husband and wife) with medical topics many biologics (Avastin). In addition, medications are frequently
such as childbirth, menstrual disorders, sexuality and infertility. used off‐label in the psychiatric and pain management settings. I
The issues chosen for presentation are based on an analysis of will start this presentation with the various definitions of off‐
approximately 5,000 out of over 14,000 questions presented to a label use of medications and the scope of using it in various
clinical settings and in different countries. Then I will describe the
inherent tension and key players in this practice. Next I will
ADDENDUM

discuss the advantages and negative consequences of its use, as
well as the research ethics and patient rights' perspectives of this DOCTOR COMPETENCIES IN MEDICAL ETHIC AND
practice. I will then focus on off‐label use in disaster settings. In EFFECTIVE COMMUNICATION SKILL AMONG THE ALUMNI
particular, I will discuss medications which had actually been OF FACULTY OF MEDICINE UNIVERSITAS AIRLANGGA

used off‐label in disasters and the ethical issues that evolved
Lilik Djuari, Agung Pranoto, Siti Pariani, Subur Prajitno,
from its use. In the last section I will discuss whether or not
Ivan Rahmatullah
regulation of off‐label use in disasters is warranted. Finally, I will
Universitas Airlangga, Indonesia
try to determine why or why not models of off‐label use which
lilikdjuari@yahoo.com
exist in other relevant fields (e.g. epidemiology, emergency
medicine) should be applied to the disaster setting and propose Indonesian Doctor Competency Standard (SKDI) 2012 mandated
guiding principles for use of off‐label medications in disaster that every physician should acquire competencies in acting
settings. according to medical ethic principal, and information exchange
verbally and nonverbally with patient, and the family member.
These competencies have significant contribution to better
THE RATIONALE OF THE EUROPEAN UNION HUMAN health outcomes among the patients. Faculty of Medicine
EMBRYONIC STEM CELL RESEARCH FUNDING Universitas Airlangga (FMUA) conducted a tracer study in 2013
that assessed their alumni competence in those area. The study
Jana Zuscinova questioned 75 users of the alumni who graduated from the
European Parliament, Brussels faculty in 2010, 2011, and 2012 about the aspects of medical
jana.zuscinova@europarl.europa.eu ethics and effective communication competencies, including

European Union funds research projects involving human medical ethic implementation at clinical work, communication
embryonic stem cells since 1998 within its multi‐annual skill with patient, the family member, and colleagues. The
Framework Programme for Research and Innovation. percentage of the users who perceive that the alumni practice
Compromise achieved among EU Member States was decided to good medical ethic is 78.3%. Meanwhile, the percentages of
be maintained also in current research programme Horizon 2020 those who perceive that the alumni practice good
for the period of 2014‐2020. Several aspects of human communication with patient, and the family member are 71%,
embryonic stem cells research are critically discussed with regard and 71% respectively. In general, this study exhibited decent
to constantly present argument of potential treatments for results. However, this results still do not reflect whether the
currently untreatable diseases. Call for clarity of scientific and alumni incorporate four medical ethics, respect for autonomy,
ethical language in debate on the EU level is accentuated. Recent beneficence, nonmaleficence, and justice into their daily
legal developments represented by decision of the Court of communication practice at clinical work. The medical education
Justice of the European Union in case Brüstle vs. Greenpeace on program at the faculty teach the medical ethic and effective
non‐patentability of biotechnological inventions derived from communication skills courses during preclinical phase with the
human embryonic stem cells and also European Citizens’ total of five credits. Therefore, the next tracer study will be
Initiative One of Us bring forward necessity of re‐evaluation of required to evaluate more specific aspects of the medical ethic
the EU approach. After almost three decades of the EU discussion and communication skills implemented by the alumni in order to
on human embryo research, it remains to be controversial. improve the teaching curriculum.

Abstracts
Hebrew Presentations
‫‪Abstracts of Hebrew Presentations‬‬ ‫‪83‬‬
‫הגופנית‪ .‬סיבות אלה יכולות לעודד עמדות שליליות מצד‬ ‫פרטיות המידע הרפואי בעידן רשתות חברתיות‬
‫פיזיותרפיסטים כלפי אנשים עם משקל יתר‪.‬‬
‫מטרת הרצאה זו היא הצגה של תפיסות ועמדות אודות אנשים עם‬ ‫שולמית אוחנה‬
‫עודף משקל‪/‬השמנת יתר בקרב פיזיותרפיסטים מוסמכים‪ .‬‬ ‫מרכז רפואי קפלן‬
‫‪Shula_o@zahav.net.il‬‬
‫‪ ‬‬ ‫חובת הסודיות הרפואית נכללה עוד בשבועת היפוקרטס‪ ,‬המורה בין‬
‫‪ ‬‬
‫תשאול צוות רפואי לגבי אלימות במשפחה‪:‬‬ ‫היתר על שמירתה‪ .‬זכות הפרט לסודיות רפואית הינה זכות יסוד‬
‫היבטים אתיים וחוקיים‬ ‫הנכללת במסגרת זכותו של אדם לפרטיות‪.‬‬
‫מעמדה של זכות זו קיבל אופי חוקתי עם עיגונה בחוק יסוד‪ :‬כבוד‬
‫מירב בן נתן‬ ‫האדם וחירותו ועם חקיקת חוק זכויות החולה קיבלה החובה‬
‫ביה"ס האקדמי לסיעוד בהלל יפה‬ ‫לשמור על סודיותו הרפואית של מטופל משנה תוקף‪ .‬‬
‫‪meraav@hy.health.gov.il‬‬ ‫בעידן המודרני‪ ,‬אחד המאפיינים הבולטים של התפתחות‬
‫תופעת האלימות כלפי נשים בישראל הינה שכיחה ובעייתית‪.‬‬ ‫הטכנולוגיה‪ ,‬הינו התפשטות הרשתות החברתיות‪,‬‬
‫ההערכה לשיעור התופעה בישראל עומדת על כ‪145,000-200,000 -‬‬ ‫והפיכתן לפלטפורמת תקשורת נפוצה עבור מיליוני משתמשים‬
‫נשים מוכות‪ .‬לפי הנתונים‪ ,‬כל אישה שביעית הוכתה בידי בן זוגה‬ ‫וביניהם גם הצוות הרפואי והמטופלים‪.‬‬
‫לפחות פעם אחת בחייה‪ ,‬ובממוצע פעם בחודש נרצחת אישה בידי‬ ‫בד בבד מתרחשת מהפיכה תרבותית וטכנולוגית במערכת הבריאות‪,‬‬
‫בן‪-‬זוגה‪ .‬למרות הנתונים היקף תופעת האלימות אינו ידוע במדויק‬ ‫אשר מתמודדת עם אתגרים של הרחבת הקשר הבלתי אמצעי של‬
‫לא כל המקרים מדווחים‪ ,‬המקרים המדווחים הם קצה הקרחון‪.‬‬ ‫הצוות הרפואי עם המטופלים‪ .‬התקשורת האינטרנטית עוברת‬
‫עפ"י נתוני סקר ארצי שנערך בשנת ‪ ,2000‬ניתן לשער כי כ‪40,215 -‬‬ ‫לעידן של העצמת מטופלים וגישה מתרחבת למתן מידע רפואי‪,‬‬
‫נשים נזקקות לטיפול רפואי מדי שנה בגלל תוקפנות בן הזוג‬ ‫חינוך לבריאות ומידע למטופלים עם עניין משותף‪.‬‬
‫כלפיהן‪.‬‬ ‫מדובר במגמה שהולכת וגוברת של שימוש באמצעים טכנולוגיים‬
‫אי לכך על מנת להגן ולסייע לנשים אלה יצא חוזר מנכ"ל בתאריך‬ ‫חדישים לשם מעקב רפואי‪ ,‬הזנת מידע ואף לשם הענקת טיפול‪.‬‬
‫‪ – 23.2003‬איתור וטיפול בנשים נפגעות אלימות במשפחה ע"י‬ ‫ברחבי העולם יש כיום יותר מ‪ 10,000-‬אפליקציות בתחומי רפואה‬
‫מטפלים במסגרות הבריאות – באשפוז ובקהילה‪ .‬חוזר זה דורש‬ ‫ואיכות חיים‪ ,‬הזמינות לכולם‪ .‬סקרים שונים שנעשו בארצות‬
‫לבצע תשאול לכל אישה הנזקקת לטיפול רפואי על היותה אישה‬ ‫הברית הצביעו על שביעות רצון של המשתמשים באפליקציות‪ ,‬על‬
‫נפגעת אלימות במשפחה‪ .‬לדרישה זו יתרונות רבים עבור הנשים‬ ‫שיפור בנגישותו של הסיוע הרפואי‪.‬‬
‫אולם מנגד מעמידה הדרישה את הצוות הרפואי בלבטים אתיים‪.‬‬ ‫לצד היתרונות‪ ,‬רשתות חברתיות פותחות את הדלת לגישה בלתי‬
‫הרצאה זו תציג את הלבטים האתיים והחוקיים בסוגית התשאול‬ ‫הולמת‪ ,‬שימוש לרעה‪ ,‬גילוי של נתונים רפואיים אישיים וחשיפת‬
‫האוניברסלי של מטופלות לגבי אלימות במשפחה‪.‬‬ ‫מידע רפואי לגורמים לא מורשים‪ ,‬לרבות‪ ,‬ניצול המידע לשימוש‬
‫מסחרי‪ .‬הסכנות שמציבה בפתחה המדיה החברתית עשויות להיות‬
‫‪ ‬‬ ‫דרמתיות למטופלים‪ ,‬בשל אופי השימוש בנתונים שפורסמו ובשל‬
‫האחות בפסיכיאטריה משפטית‪ ,‬סוהר או סוכן טיפול‬ ‫ההשלכות הנובעות מהפרת הפרטיות‪.‬‬
‫סיעודי? כפל הנאמנות של אחות בפסיכיאטריה‬ ‫בשנת ‪ 2013‬פורסם בארצות הברית דו"ח הקובע כי כמעט ‪ 30‬מיליון‬
‫אמריקאים גילו כי המידע הרפואי האישי שלהם נפרץ מאז שנת‬
‫דור בר נוי‪ ‬‬ ‫‪ .2009‬ההיבט המדאיג יותר הוא שכמעט ‪ 50‬אחוז מהארגונים אינם‬
‫מרכז לבר"ן שער מנשה‬ ‫מודעים לסיכונים אלו‪ .‬‬
‫‪Dor@sm.health.gov.il; dorbarnoy@gmail.com‬‬
‫רקע‪ :‬מחלקות‪ ‬לפסיכיאטריה‪ ‬משפטית‪ ‬מאופיינות‪ ‬בתשתיות‪ ‬פיזיות‪ ‬‬
‫‪ ‬‬
‫המדמות ‪ ‬מתקן ‪ ‬כליאה‪ ,‬ומתמקדות ‪ ‬באבחון‪ ,‬מתן ‪ ‬חוות ‪ ‬דעת ‪ ‬‬ ‫עמדות ותפיסות כלפי אנשים עם עודף משקל‪/‬השמנת יתר‬
‫פסיכיאטריות ‪ ‬וטיפול ‪ ‬במטופלים ‪ ‬אלימים‪ ,‬שביצעו ‪ ‬מעשה ‪ ‬פלילי‪,‬‬ ‫בקרב פיזיותרפיסטים מוסמכים‬
‫והמאושפזים ‪ ‬בכפייה‪ .‬במחלקות המשפטיות הניגוד ‪ ‬שבין ‪ ‬העיסוק ‪ ‬‬
‫מיכל אלבוים גביזון‬
‫בסיעוד ‪ ‬פסיכיאטרי‪ ,‬לבין ‪ ‬העיסוק ‪ ‬בשמירה ‪ ‬על ‪ ‬בטחון ‪ ‬מעלה את‬ ‫אוניברסיטת חיפה‬
‫שאלת תפקידו של הסיעוד בפסיכיאטריה משפטית – סוהר או סוכן‬
‫טיפול סיעודי?‪.‬‬ ‫‪Michal.elboim@gmail.com‬‬
‫‪ ‬‬
‫תחומי המחקר‪ (1 :‬הכרת סביבת העבודה והיחס בין שמירה על‬ ‫‪) Obesophobia‬שמנופוביה( הוא מושג המתייחס לפחד וחרדה‬
‫בטיחות לעומת מקצועיות ‪ (2‬תפיסת תפקיד מקצועית בדגש על‬ ‫מאנשים בעלי עודף משקל‪ ,‬היוצרים מסכת של עמדות ותפיסות‬
‫הקשר בין סביבת העבודה למרכיבים אישיים והשפעתם על כוונות‬ ‫כלפי האדם השמן ומייחסים לו תכונות נלוות שליליות כמו עצלנות‬
‫התנהגות מקצועיות‪.‬‬ ‫והיעדר משמעת עצמית‪.‬‬
‫מטרות המחקר‪ (1 :‬בחינת השפעת סביבת העבודה על תפיסת‬ ‫תופעת עודף המשקל מוכרת בעשורים האחרונים כמגיפה כלל‬
‫התפקיד ושביעות רצון מהעבודה במחלקות פסיכיאטריות‪(2 .‬‬ ‫עולמית‪ ,‬במדינת ישראל נמצא ש‪ 49% -‬מהאוכלוסייה סובלת מעודף‬
‫בדיקת הקשר בין אקלים הבטיחות לתפיסת תפקיד הצוות הסיעודי‬ ‫משקל או השמנת יתר‪.‬‬
‫במחלקות פסיכיאטריות משפטיות בהשוואה למחלקות‬ ‫מספר רב של מחקרים הדגימו את תופעת השמנופוביה בקרב‬
‫פסיכיאטריות אחרות‪ .‬‬ ‫רופאים ושאר אנשי מערכת הבריאות המלווים בהשלכות שליליות‬
‫השערות מחקר‪ .1 :‬ימצא הבדל בתפיסת האחות את תפקידה‬ ‫על הטיפול הרפואי הניתן לאוכלוסייה זו‪ .‬תופעת ההשמנה דווחה‬
‫במחלקות משפטיות לעומת אחיות במחלקות אחרות‪.2 .‬קיים קשר‬ ‫כסיטואציה שלילית ע"י רופאים‪ ,‬כאשר קדמו לה שלושה‬
‫בין אקלים הבטיחות לתפיסת האחות את תפקידה‪.3 .‬קיים קשר בין‬ ‫סיטואציות שליליות נוספות והם התמכרות לסמים‪ ,‬אלכוהוליזם‬
‫תפיסת האחות את תפקידה לבין כוונות התנהגות )טיפול לעומת‬ ‫ומחלות נפש‪ .‬נמצא שחלק לא מבוטל מהדיאטניות מביעות רגשות‬
‫שליטה(‪.‬‬ ‫שלילים יותר כלפי המטופלים השמנים‪ .‬רגשות אלו הובילו‬
‫שיטה – ‪ ‬ישתתפו ‪ 191‬אחים‪/‬אחיות ממחלקות משפטיות‪ .‬ו‪91-‬‬ ‫להתנהגות שלילית מצדם ולאפליה שבאה לידי ביטוי בהימנעות‬
‫אחים‪/‬אחיות מחמישה מחלקות פסיכיאטריות בבתי חולים‬
‫כלליים‪ .‬כלי המחקר הנו שאלון מובנה להשבה עצמית הכולל‪:‬‬ ‫ממגע בין בין‪-‬אישי וזמן טיפול קצר יותר מזה שניתן לאחרים‪.‬‬
‫שאלות לגבי תפיסת תפקיד האחות בפסיכיאטריה‪ ,‬אקלים בטיחות‬ ‫האם בעולם המקצועי של הפיזיותרפיה קיימת תופעת השמנופוביה?‬
‫בעבודה‪ ,‬כוונות התנהגות ושביעות רצון מהעבודה‪.‬‬ ‫תופעה‪ ,‬שהינה הפרה מתמשכת של אחד מהסעיפים הבסיסים של‬
‫תרומות המחקר – בתחום הקליני – הכרות עם הכוחות בשדה‬ ‫הקוד האתי המקצועי והוא "הפיזיותרפיסט ימנע מאפליה‪ ,‬קבלת‬
‫הקליני תאפשר לממונים לבחון באם העשייה הסיעודית בפועל‬ ‫החלטות מקצועיות או משוא פנים‪ ,‬בגין מחלה‪ ,‬נכות‪ ,‬מגדר‪ ,‬דת‪,‬‬
‫תואמת את העקרונות שמנסה הארגון להנחיל‪ .‬בתחום המנהלי –‬ ‫לאום וגיל‪".‬‬
‫התוצאות עשויות לסייע בהבנייה מחודשת של הגדרת תפקיד הצוות‬ ‫השאלה המתעוררת היא‪ :‬האם הסטנדרטים המקצועיים של‬
‫הסיעודי בפסיכיאטרייה בכלל ובפסיכיאטרייה משפטית בפרט‪.‬‬ ‫הפיזיותרפיסטים מושפעים מעמדות שלילות על אוכלוסיית‬
‫בתחום החינוכי – בניית תוכנית לימוד והתנסות מותאמות לשדה‬ ‫המטופלים בעלי משקל עודף? ישנם‪ ,‬היבטים ייחודים בנוגע לתופעת‬
‫הקליני‪ .‬בתחום המחקרי – חקר השפעת אקלים הבטיחות בעבודה‬ ‫ה‪"-‬שמנופוביה" בקרב הפיזיותרפיסטים נוכח העובדה שעבודתם‬
‫והשפעתו על תפיסת התפקיד עשוי לפתוח נתיב מחקרי חדש‪.‬‬ ‫כרוכה לעיתים קרובות במגע פיזי ישיר עם המטופל‪ .‬כמו כן‪ ,‬הטיפול‬
‫הפיזיותרפי באדם הסובל מהשמנה יכול אף להיות תובעני ברמה‬
‫‪84‬‬ ‫‪UNESCO Chair in Bioethics 10th World Conference‬‬
‫ושל רב המרכז הרפואי כמו שקורה ב"מעיני הישועה"‪ ,‬ע"י כך ניצלו‬ ‫קדושת החיים ובדיקות סקר עפ"י פסקי הלכה של גדולי‬
‫וניצלים חיי עוברים לא מעטים! ‪ ‬‬ ‫הרבנים בישראל בדור האחרון‬
‫‪ ‬‬ ‫מנחם חיים ברייר‬
‫מרכז רפואי מעיני הישועה‬
‫להתריע או לא להתריע‪ :‬הגישה ההלכתית יהודית‬
‫‪rsabag@mhmc.co.il‬‬
‫חיה גרינברגר‬
‫בית הספר למקצועות הבריאות‪ ,‬המרכז האקדמי לב‬ ‫‪ (1‬חולה סופני הנוטה למות‪ :‬בדעת תורה שנפסקה לפני ‪ 20‬שנה‬
‫‪ greenber@jct.ac.il‬‬ ‫)שנחתמה ע"י הרבנים הרב ‪ ‬‬
‫אלישיב זצ"ל והרב שלמה זלמן אויעארבך זצ"ל ויבדלו לחיים‬
‫הגישה ההלכתית היהודית להתרעה של האחות על טעות או רשלנות‬ ‫ארוכים הרב שמואל הלוי ואזנר שליט"א‬
‫מקצועית משקפת את המתח בין שתי חובות שיכולות לעמוד‬ ‫ורבי ניסים קרליץ שליט"א בי"ט כסלו תשנ"ה( נאמר‪:‬‬
‫בסתירה אחת עם רעותה‪ .‬מצד אחד‪ ,‬אנו מצווים להציל אדם מעולה‬ ‫יש לטפל בחולה סופני הנוטה למות בכל התרופות והטיפולים‬
‫נוכחית או פוטנציאלית העלולה להתרחש‪ ,‬אך מצד שני‪ ,‬אנו מצווים‬ ‫הרפואיים השגרתיים כמו בחולה אחר‬
‫נגד הלשנה‪ .‬הדילמה סביב ההרתעה נעשית מורכבת יותר בהתחשב‬ ‫ואין לקרב קיצו בכל דרך כדי להקל על סבלו‪.‬‬
‫עם החובה להוכיח את עמיתנו‪ ,‬כלומר להעמיד אותם על חומרת‬ ‫הטיפול התרופתי המצוין הינו הזנה ע"י זונדה או עם גסטרוסטום‬
‫מעשיהם‪.‬‬ ‫או עם פג‪ ,‬עירוי נוזלים ‪ ,IV‬אינסולין‪,‬‬
‫יובאו לדיון משקלם של המרכיבים הבאים בהליך קבלת ההחלטות‬ ‫מורפיום במינון מבוקר‪ ,‬אנטיביוטיקה‪ ,‬מנות דם לפי הצורך‬
‫בעניין ההרתעה מההיבט ההלכתי‪:‬‬ ‫הרפואי‪ .‬במהלך השנים התווסף שאם‬
‫• חומרת המעשה‪ ,‬לכאורה‬ ‫נכנסה בעיה רפואית צדדית במהלך המחלה הממאירה אזי לפי‬
‫• אמינות העובדות הידועות‬ ‫הצורך מנשימים את החולה כמו בפניאומוניה דלקת ריאות שבעטיה‬
‫• מערכת היחסים בין המרתיע והמבצע‪ ,‬לכוראה‬ ‫החולה נכנס למצוקה נשימתית המאיימת על חייו‪ TPN ,‬הזנת על‬
‫• מאפייני המערך הארגוני בתוכו מתרחש האירוע‪ ,‬לכוראה‬ ‫תוך ורידית ודיאליזה‪.‬‬
‫• הסיכוי שדברי המרתיע יתקבלו וייעשה בהם שימוש נכון‬ ‫הדברים משתנים כשנכנס החולה למצב של גסיסה שאלו הם ה‪72 -‬‬
‫שעות האחרונות לחייו )עד כמה שאפשר לחזות( שאז צריך לשקול‬
‫• הסכנה הצפויה למרתיע‬ ‫את הטיפול הרפואי המתאים ולהזהר שלא לשנע אותו שלא לצורכו‪.‬‬
‫‪ ‬‬ ‫‪ (2‬סרטן השד‪ :‬לפני ‪ 13‬שנה בנושא של סרטן השד קבעו ‪ 4‬רבנים‬
‫המובילים בעולם )הרב שלום אלישיב זצ"ל‪ ,‬הרב אהרון לייב‬
‫משתנים המשפיעים על התמודדות אנשי הצוות הרפואי עם‬ ‫שטיינמן‪ ,‬הרב שמואל הלוי ואזנר והרב ניסים קרליץ( שיש לבצע‬
‫פטירת תינוק במחלקה לטיפול נמרץ בילוד‬ ‫בדיקות סקר בנשים‪.‬‬
‫‪2‬‬
‫סופיה דומבה‪ ,1‬נילי טבק‪ ,2‬שולמית קרייטלר‬ ‫הוראתם היא‪ :‬שכיום ישנה אפשרות לכל אחת באופן קל לבחון‬
‫‪ 1‬מרכז רפואי אסף הרופא‬ ‫בעצמה ענינים יסודיים של בריאות גופה ולעמוד על המשמר ולקדם‬
‫‪ 2‬אוניברסיטת תל אביב‬ ‫פני רעה במחלה הידועה‪ .‬דבר גדול ונשגב עושים בזה כי זה נוגע‬
‫לפיקוח נפש וודאי ראוי שכל אחת תקבל הדרכה בענינים אלו לקיים‬
‫‪Sophyd@012.net.il‬‬
‫"רק השמר לך ושמור נפשך" וכו'‪.‬‬
‫אחד האירועים הקשים ביותר שחווים אנשי צוות רפואי העובדים‬ ‫ולפי הרמב"ם זו מצות עשה לשמירת הגוף‪.‬‬
‫במחלקות טיפול נמרץ בילוד במהלך עבודתם הוא פטירת תינוק‬ ‫מאז עלו מס' הבדיקות בציבור החרדי ובציבור שומרי התורה‬
‫במחלקה‪ .‬מתוך הספרות העולמית בנושא העוסקת בקשיים‬ ‫והמצוות דהיינו בדיקות ממוגרפיה‪ ,‬אולטרה סאונד וביאופסיות‪.‬‬
‫שבהתמודדות רופאים ואחיות עם פטירת מטופל עולה כי הם חווים‬ ‫ב"מעיני הישועה" מרכז רפואי המתנהל עפ"י תורת ישראל נעשים‬
‫תהליך אבל הדומה לזה של המשפחות‪ .‬המחקר יתמקד בתהליך זה‬ ‫כ‪ 420 -‬בדיקות ממוגרפיה לחודש‪ ,‬כ‪ 5000 -‬לשנה!‬
‫ובמשתנים המשפיעים על עוצמת תגובותיהם ודרכי התמודדותם של‬ ‫‪ (3‬בדיקות קולונוסקופיה הומלץ מאוד ע"י הרבנים לבצע זאת‬
‫אנשי הצוות‪ .‬השערות המחקר מתייחסות לקשרים שבין אירוע‬ ‫כבדיקות סקר באוכלוסיה לגילוי מוקדם של ממאירות המעי הגס‬
‫פטירת התינוק לבין תגובת איש הצוות )תהליך אבל( והמשתנים‬ ‫מעל גיל ‪ 50‬ארעות המחלה מעל גיל ‪ 50‬הינה ‪ 6%‬דהיינו ‪ 1‬ל‪ 17 -‬איש‬
‫המתווכים ביניהם – פחד ממוות ומשאבים‪ .‬ובנוסף‪ ,‬לקשרים שבין‬ ‫מדובר בשכיחות גבוהה‪ .‬‬
‫תהליך האבל אותו חווה איש הצוות לבין תגובות של תסמינים‬ ‫‪ (4‬חולה דמנטי חסר דעה‪ :‬לפני כחודשיים נפסק ע"י ‪ 9‬רבנים‬
‫פוסט טראומתיים‪ ,‬לשחיקה ולצמיחה‪ .‬מדגם המחקר יכלול ‪200‬‬ ‫מגדולי הדור בהקשר לחולה דמנטי‪ -‬חסר דעה שיש חובה לטפל בו‬
‫רופאים ואחיות העובדים במחלקות טיפול נמרץ בילוד במספר בתי‬ ‫כדרך שחובה לטפל בחולה הצלול בדעתו‪ .‬כמו כן אין לחלק בין‬
‫חולים בישראל‪ .‬נתוני המחקר יאספו באמצעות שאלון שנבנה על ידי‬ ‫חולה צעיר לזקן‪ .‬‬
‫החוקרת ומורכב משאלונים קיימים ומשאלות שנוספו על ידי‬ ‫חיוב ההצלה הוא גם לחיי שעה דהיינו לזמן קצר ועבור זה מחללים‬
‫החוקרת‪ .‬בפיילוט שנערך נמצאה עקביות פנימית גבוהה בין משתני‬ ‫שבת לקיים "ולא תעמוד על דם רעך" ומצווה לפרסם ברבים דין‬
‫המחקר ואחד הממצאים הבולטים הוא שעד רמת שחיקה בינונית‪,‬‬ ‫פשוט זה‪ .‬הפסק הנ"ל מתאים ל"חוק זכויות החולה" עפ"י‬
‫הצמיחה גבוהה יותר‪ .‬ואילו כשרמת השחיקה היא גבוהה מבינונית‪,‬‬ ‫המחלקה המשפטית של משה"ב‪.‬‬
‫יש ירידה ברמת הצמיחה‪ .‬מכאן שלשחיקה יש כנראה השלכה על‬ ‫חתומים הרבנים‪ :‬הרב שמואל הלוי ואזנר‪ ,‬הרב אהרון לייב‬
‫היכולת והמוטיבציה לצמיחה‪ .‬עולות מנושא המחקר סוגיות‬ ‫שטיינמן‪ ,‬הרב ניסים קרליץ‪ ,‬הרב חיים קניבסקי‪ ,‬הרב יצחק‬
‫אתיות‪ :‬מהי החובה האתית של מערכת הבריאות כלפי המטפלים‬ ‫זילברשטיין‪ ,‬הרב שלום כהן ‪ ,‬הרב שמעון בעדני‪ ,‬הרב משה שאול‬
‫ומאידך‪ ,‬חובת המטפלים כלפי מטופליהם? ממצאי המחקר עשויים‬ ‫קליין‪ ,‬הרב שריאל רוזנברג‪.‬‬
‫יהיו לתרום להבנת סוגיות אלו ובמציאת פתרונות עתידיים‬ ‫בישראל יש כ‪ 120.000 -‬דמנטים ואולי יותר ויש כ‪ 320.000 -‬איש‬
‫במערכת מטפל ‪ -‬מטופל ובאיכות הטיפול במחלקות טיפול נמרץ‬ ‫זקנים מעל גיל ‪ 75‬ובעולם מליונים רבים‪ .‬קביעות אתיות מוסריות‬
‫בילוד‪ .‬בנוסף‪ ,‬הממצאים יוכלו להגביר את המודעות לצורך בטיפול‬ ‫אלו יש להם גם השלכות משמעותיות בשטח‪.‬‬
‫במטפל‪ ,‬שפעמים רבות מדי אינו מקבל את המקום הראוי לכך‬ ‫בשנים האחרונות אנחנו מוצאים יותר ויותר חולים מונשמים בתוך‬
‫במציאות של ימינו‪ .‬‬ ‫מחלקות יעודיות למונשמים ברחבי ישראל‪.‬‬
‫‪ ‬‬ ‫‪ (5‬בדיקות סקר גנטיות "דור ישרים" למספר מחלות גנטיות‬
‫רצסיביות חמורות‪ .‬הבדיקות נעשות בציבור החרדי והדתי לרווקים‬
‫עמדות של אחיות מוסמכות אקדמיות כלפי אתיקה בפרסום‬ ‫ולרווקות לפני פגישות הכרות ע"מ למנוע נישואין של בני זוג נשאים‬
‫מדעי‬ ‫של מחלה גנטית סמויה כדי למנוע מחלות גנטיות שכיחות בילדים‬
‫נילי טבק‪ ,‬סמיון מלניקוב‪ ,‬צביה בר‪-‬נוי‬ ‫הנולדים‪ .‬מדובר במחלות א( ציסטיק פיברוזיס ב( טאי זקס ‪ ‬‬
‫ג( דיסאוטונומיה משפחתית‪ ,‬ד( ‪ CANAVAN DIS‬ה( ‪FANCONI ‬‬
‫‪ntabak@post.tau.ac.il; tabak.nili@gmail.com‬‬
‫‪ ANEMIA‬מסוג ‪ C‬ו( תסמונת בלום ז( נימן פיק ח( מחלת אגירה‬
‫רקע‪ :‬מאמר מדעי הוא תוצאה של ייצור ידע על בסיס מחקרי‪ .‬על‬ ‫גליקוגן מסוג ‪ 1‬ט( ‪MUCOLIPIDOSIS ‬טיפ ‪ . 4‬עד היום נבדקו כ‪-‬‬
‫מנת שהמאמר יעמוד בקריטריונים מקובלים הוא חייב להיות בהיר‬ ‫‪ 350.000‬צעירים וצעירות בישראל! ‪ ‬‬
‫בכתיבה‪ ,‬מדויק בעובדות‪ ,‬מיוחד בנושא ואובייקטיבי בנתונים‪ .‬יחד‬ ‫‪ (6‬הפסקת הריון ‪ -‬עקב העדר דופק של העובר תעשה הפסקת‬
‫עם זאת‪ ,‬לא פעם נתקלים באי שמירה על היושר ונורמות אתיות‬ ‫הריון רק לאחר אבחון ודאי של ‪ 2‬רופאים מיומנים באולטרה סאונד‬
‫במחקר ופרסום‪ .‬בין הבעיות הנפוצות בפרסום מאמר מדעי –‬
‫‪Abstracts of Hebrew Presentations‬‬ ‫‪85‬‬
‫אוכלוסיית מחקר‪ :‬קבוצות של אחיות ורופאים בישראל ובמדינות‬ ‫פרסום כפול‪ ,‬גניבה ספרותית והוספת אנשים בתור מחברים למרות‬
‫חבר העמים‪.‬‬ ‫שלא תרמו תרומה מספקת לכתיבת מאמר‪.‬‬
‫מטרת המחקר‪ :‬בחינה ותיאור תהליכי קבלת החלטות מוסריות‬ ‫מטרת המחקר‪ :‬לבחון עמדות של אחיות מוסמכות אקדמיות כלפי‬
‫בסיטואציות טיפוליות לא שגרתיות‪ ,‬וזיהוי הרכיבים האפיסטמיים‬ ‫אתיקה בפרסום מדעי‪.‬‬
‫והמוסריים המשפיעים על תהליך זה‪.‬‬ ‫שיטות‪ :‬אוכלוסיית המחקר‪ :‬אחיות אקדמאיות הלומדות במדרשה‬
‫שיטות מחקר‪ :‬סימולאציה של סיטואציה טיפולית על פי שני‬ ‫לתארים מתקדמים בחוג לסיעוד באוניברסיטת תל אביב ואחיות‬
‫תרחישים‪ ,‬ראיון מובנה בקבוצות מיקוד‪ ,‬ראיון מאזכר בתום ראיון‬ ‫אקדמאיות העובדות במרכזים רפואיים גדולים במרכז הארץ‪.‬‬
‫מובנה‪ .‬דיווח פרטני על החוויה של האינטראקציה הטיפולית‬ ‫הליך‪ :‬מחקר סקר‪ .‬הנתונים ייאספו באמצעות שאלון מובנה למילוי‬
‫הסימולאטיבית ודיווח קבוצתי‪.‬‬ ‫עצמי בקרב כ‪ 100-‬אחיות אקדמאיות‪.‬‬
‫שלבי המחקר‪:‬‬ ‫כלים‪ :‬שאלון מובנה למילוי עצמי שיבחן עמדות לגבי אתיקה‬
‫• סימולאציה של אינטראקציה טיפולית‪ :‬הצגת סיטואציה‬ ‫בפרסום‪ ,‬סוגיות אתיות במחקר והתנהגות לא אתית של חוקר‪.‬‬
‫טיפולית‪ ,‬שאיננה מייצגת את הפרקטיקה ואת הנורמות‬ ‫תרומת המחקר‪ :‬ממצאי המחקר יסייעו לשפוך אור על הגורמים‬
‫השכיחות; הגדרת עמדה אישית ביחס לפנייתו של המטופל‬ ‫שעשויים להשפיע על העמדות אל אחיות אקדמאיות לגבי האתיקה‬
‫ונימוק עמדה זו;‪ ‬קבלת החלטה טיפולית ‪ ‬‬ ‫בפרסום המדעי‪ .‬מתוך כך יהיה ניתן להתוות מדיניות לעמידת‬
‫• קבוצת מיקוד ודיון על עמדות אישיות‪ ,‬נימוקים של העמדות‬ ‫אחיות חוקרות במידות אתיקה מקובלות‪.‬‬
‫וביסוס ההחלטות ‪ ‬‬
‫• ראיון מאזכר להבהרת התהליכים והגורמים בהן גובשו העמדות‬ ‫‪ ‬‬
‫האישיות ‪ ‬‬ ‫הטמעת הקוד האתי בקרב סטודנטים לסיעוד‬
‫תוצאות המחקר‪:‬‬ ‫עדי ליברטי‬
‫• המשתתפים מכירים את עקרונות המוסר ושואפים לממש אותם‬
‫בפרקטיקה המקצועית‬ ‫במסגרת השנה השלישית בלימודי סיעוד כוללת תכנית הלימודים‬
‫• האינטואיציה המוסרית של המטפלים בסיטואציות טיפוליות‬ ‫קורס אתיקה שחלק ניכר ממנו מוקדש לקוד האתי של האחים‬
‫לא שגרתיות מוטה בעקבות תגובותיהם הרגשיות ‪ ‬‬ ‫והאחיות בישראל‪ ,‬ובהתאם גם בבחינת הסיכום של הקורס מוקדש‬
‫• המשתתפים משתמשים בידע מקצועי לרציונליזציה של‬ ‫חלק ניכר לקוד אתי זה‪.‬‬
‫ההחלטות אישיות ‪ ‬‬ ‫מטרת מחקר זה לבדוק את מידת התמיכה בשימוש בקוד האתי‬
‫בקרב אנשי סיעוד‪.‬‬
‫• המשתתפים נוטים לפטרנליזם והיעדר אמפתיה בסיטואציות‬ ‫במסגרת מחקר זה נבדקו עמדות של סטודנטים בשנה הרביעית‬
‫קונפליקטואליות‬ ‫ללימודי הסיעוד )שלמדו בשנה הקודמת קורס אתיקה( וכן של‬
‫התמות המרכזיות בתום שלבי המחקר‪:‬‬ ‫אחים ואחיות מוסמכים ביחס לקוד האתי של האחים והאחיות‬
‫• קונפליקט ערכי ‪ ‬‬ ‫בישראל‪.‬‬
‫• רכיבים רגשיים בתגובות ‪ ‬‬ ‫המדגם כלל כ‪ 150-‬סטודנטים לסיעוד מחמישה בתי ספר שונים‬
‫• נטייה לשיפוטיות ‪ ‬‬ ‫לסיעוד וכ‪ 30-‬אחים ואחיות ממגוון תחומים קליניים‪.‬‬
‫• אתנוצנטריזם ‪ ‬‬ ‫המחקר בדק את השימוש שהם עושים בקוד האתי בהטמעת הקוד‬
‫• פטרנליזם‬ ‫כמצפן מקצועי‪ ,‬חשיבות הלימוד שלו בעיניהם ואיזה ערך מהערכים‬
‫מסקנות‪ :‬תהליך הכשרה של המטפלים כיום מבוסס בעיקרו על‬ ‫המנויים בקוד האתי זוכרים הנבדקים והוא נחשב בעיניהם לחשוב‬
‫גישה אפיסטמית אינטרנליסטית‪ ,‬המנחה לקבלת החלטות על בסיס‬ ‫ביותר‪.‬‬
‫ראיות מחקריות וגוף ידע מקצועי‪-‬טענתי‪ .‬אינטראקציות טיפוליות‬ ‫תוצאות המחקר הצביעו על ידע דלקרטיבי רב יותר מצידם של‬
‫המעוררות קונפליקט מניעות לתהליך קבלת החלטות אינטואיטיבי‬ ‫הסטודנטים לעומת אחים ואחיות מוסמכים; יחד עם זאת‪ ,‬ניכר‬
‫בהתאם לגישה אפיסטמית אקסטרנליסטית‪ .‬המלצת המחקר –‬ ‫באופן בולט הו בקרב הסטודנטים והן בקרב האחים והאחיות‬
‫פיתוח מנגנונים אפיסטמיים אקסטרנליסטים מהימנים כחלק‬ ‫המוסמכים כי נעשה שימוש מועט בקוד האתי כמקור המשמש‬
‫מהכשרה מקצועית של המטפלים‪.‬‬ ‫לתמיכה בקבלת החלטות מקצעיות‪.‬‬
‫‪ ‬‬ ‫‪ ‬‬
‫ידע ועמדות של אחיות בתי חולים כלליים ביחס לטיפול‬ ‫דילמות אתיות בבריאות וההקשר הרב תרבותי‬
‫באסירים כבולים‬ ‫שרה ניסים‬
‫דורית רובינשטיין‪,‬מיכל פייזר‪ ,‬נורית וגנר‬ ‫ביה"ס האקדמי לסיעוד ע"ש אדית וולפסון‬
‫‪saran@son‐wolfson.co.il‬‬
‫‪dorub@hotmail.com‬‬
‫הטיפול הסיעודי במסגרות טיפוליות שונות‪ ,‬חושף לעיתים את‬ ‫משחר ההיסטוריה ועל פני כל הגלובוס‪ ,‬מתחבטים בני אדם‬
‫הצוות הסיעודי לצורך במתן טיפול לאדם כבול )אזוק(‪ .‬מצב זה יוצר‬ ‫בשאלות קיומיות ומהותיות הקשורות לחיים ומוות‪ ,‬של מה הוא‬
‫דילמות‪ .‬מחד‪ ,‬הצורך לטפל בפרט תוך שמירה על זכויותיו‬ ‫"טוב"‪" ,‬נכון"‪" ,‬ראוי"‪" ,‬בסדר"‪" ,‬מתאים" וכד'‪.‬‬
‫הבסיסיות ועל שלומו מצד שני‪ ,‬הצורך להגן על הצוות המטפל ועל‬ ‫מתוך הכרה זו‪ ,‬עולות תהיות רבות ומשמעותיות‪:‬‬
‫מטופלים אחרים בשל החשש לפגיעתם מהאסיר‪.‬‬ ‫האם ה"ערכים המכוונים" על פיהן מבססת תרבות את תשובותיה‬
‫הקונפליקט בין הגוף האחראי על שמירת האסיר לבין הגוף המטפל‬ ‫לשאלות אלו‪ ,‬הינם אוניברסליים? האם קיים בכלל מושג כזה? כיצד‬
‫לא מצא את פתרונו‪ .‬כן הנהלים הקיימים לא אפשרו טיפול נאות‬ ‫ערכים אלו יבואו לידיי ביטוי בהחלטות האתיות‪ ,‬תרבויות שונות ?‬
‫באסירים ויצרו קונפליקטים‪ .‬משרד המשפטים בהשתתפות כל‬ ‫האם יש מקום ליחסיות תרבותית בעת קבלת החלטות אתיות? ‪ ‬‬
‫הגורמים העוצרים והמטפלים באסירים‪ :‬משרד הבריאות‪ ,‬ארגוני‬ ‫בהרצאה זו אנו ננהל דיון בשאלות אלו ונבחן היבטים תרבותיים‬
‫זכויות אדם ולשכות האתיקה של הסתדרות הרופאים ושל‬ ‫הקשורים לקבלת החלטות אתיות במסגרות העוסקות בבריאות‪,‬‬
‫הסתדרות האחים‪/‬ות ניסחו נהלים חדשים‪.‬‬ ‫בחיים ובמוות‪.‬‬
‫לשכת האתיקה של הסתדרות האחיות בחרה לבדוק בסקר הנוכחי‬
‫את הקף הבעיה‪ ,‬את הידע העמדות והנכונות של אחיות לפעול‬ ‫‪ ‬‬
‫בתחום‪.‬‬ ‫רכיבים אפיסטמיים בביסוס גישה טיפולית‪-‬מוסרית‬
‫מטרות המחקר לבחון את‪:‬‬ ‫בסיטואציות קונפליקטואליות‬
‫‪ .1‬שכיחות ההיתקלויות של אחיות בטיפול באסירים כבולים‬
‫במחלקות בתי החולים‬ ‫אלה קורן‬
‫‪ .2‬הידע לגבי נהלים הקשורים בטיפול באסיר אזוק‪.‬‬ ‫בית הספר האקדמי לסיעוד ע"ש זיוה טל‪ ,‬שיבא ‪ ‬‬
‫‪ .3‬העמדות של האחיות ביחס לטיפול באדם ‪ /‬אסיר כבול )אזוק(‬ ‫‪Ella.Koren@sheba.health.gov.il‬‬
‫בבתי חולים‪.‬‬ ‫גישת המידות דוגלת בפיתוח המידות האישיות האתיות‬
‫‪ .4‬הנכונות של האחות לפעול בהקשר לטיפול באסיר כבול‪.‬‬ ‫והאפיסטמולוגיות‪ .‬המחקר המוצג מתאר תהליך של התבוננות‬
‫פנימית ותובנות לגבי התפקוד המוסרי והאפיסטמי של המטפלים‪.‬‬
‫‪86‬‬ ‫‪UNESCO Chair in Bioethics 10th World Conference‬‬
‫טעויות בטיפול והסיעוד‬ ‫אוכלוסיית המחקר – ‪ 359‬אחיות )‪ 79%‬נשים( העובדות במסגרות‬

‫אשפוז שונות בבתי חולים כלליים בארץ‪ ,‬הלומדות באחד‬
‫חיה רז‬ ‫מהקורסים העל בסיסיים‪.‬‬
‫המרכז האקדמי לב‪ ,‬בית הספר למקצועות הבריאות‬ ‫הכלי – שאלון אנונימי למילוי עצמי‪ .‬המחקר קיבל אישור וועדה‬
‫‪razhaya@gmail.com; hayar@jct.ac.il‬‬ ‫אתית מוסדית ומנהלות בתי ספר לסיעוד בהם התקיימו הקורסים‬
‫בטיחות הטיפול הוא נושא שמעסיק את עולם הרפואה מאז עבודתם‬ ‫העל בסיסיים‬
‫ממצאים – אחיות שטיפלו באסיר אזוק במהלך השנה האחרונה‬
‫של ‪ Leape‬וחב' ב‪ ,1991-‬שהרשימו את הציבור בהציגם את חומרת‬
‫הבעיה‪ .‬כחלק מהצוות הרפואי‪-‬המטפל‪ ,‬חובה גם על האחיות‬ ‫)‪ ,(n=162‬באופן מובהק היו בעלות ידע רב יותר ‪ (P <.001) T= 3.28‬‬
‫להתמודד עם טעויות בטיפול‪ .‬אחת הדרכים בקידום בטיחות‬ ‫והאמינו שלכבילה ישנה השפעה על איכות הטיפול ‪(P <.05) T =‐2.91‬‬
‫הטיפול היא הלקחים המופקים מדיווח על טעויות ועל כמעט טעות‪.‬‬ ‫יותר מאשר אחיות )‪ (n = 183‬ללא ניסיון קודם בטיפול באסיר אזוק‬
‫תובא סקירה היסטורית קצרה כיצד האחריות בטיפול הואצלה גם‬ ‫במהלך השנה האחרונה‪ .‬לא נמצא הבדל מובהק בנכונות לפעול בין‬
‫לאחות‪ .‬מתפקיד של "לויאליות בלעדית לרופא" בימי נייטינגיל דרך‬ ‫שתי הקבוצות‪.‬‬
‫"היותה סנגור של המטופל" ועד היותה מייצגת את טובת המוסד בו‬ ‫מסקנות והמלצות – שיפור הנהלים הקיימים בנושא טיפול באסיר‬
‫היא עובדת‪.‬‬ ‫הכבול‪ .‬קביעה ברורה ויידוע הצוותים הרפואיים‪ ,‬באילו תנאים‬
‫יובא תקציר המדגיש את הדילמות של האחיות כפי שמיוצגות‬ ‫אסירים ועצורים‪ ,‬הנתונים למשמורת שב״ס והמאושפזים בבית‬
‫בספרות המקצועית‪ ,‬בהתמודדות עם החובה לדווח בעולם‬ ‫חולים‪ ,‬יהיו כבולים באזיקים‪ .‬הפצת המידע על פקודת נציבות‬
‫ובישראל‪ .‬למי נתונה הלויאליות של האחות‪ :‬למקצוע‪ ,‬לרופא‪,‬‬ ‫שירות בתי הסוהר מס׳‪ 04.15.01‬משנת ‪ 2008‬בעניין ״כבילת אסיר‬
‫לצוות האחיות‪ ,‬לצוות הרב מקצועי‪ ,‬למטופל‪ ,‬למשפחתו‪ ,‬לקהילה‬ ‫במקום ציבורי״‪.‬‬
‫או למוסד שבו היא עובדת‪.‬‬
‫‪ ‬‬ ‫‪ ‬‬

Abstracts
Poster Presentations
Abstracts of Poster Presentations 89
NEW MODELS OF PUBLIC HEALTH RESEARCH: All texts are available online; the access is free of charge.
DEVELOPING AN ETHICAL FRAMEWORK FOR RESEARCH During the last twelve years the amount of participants has
USING SURVEILLANCE DATA IN RESOURCE LIMITED grown significally, and now there are 30,000 Live Journal users,
120,000 participants from other social networks, and about 400
COUNTRIES
requests and 2,8 million watches of request's discussions per
Evelyn Anane‐Sarpong1, Bernice Simone Elger1, Marcel Tanner1, month on the site http://ru_psiholog.livejournal.com.
1 2 3
Tenzin Wangmo , Osman Sankoh , Angus Dawson We report about setting, psychotherapeutic effects,
1
University of Basel, Switzerland management issues, ethical dilemmas, e‐volunteering trends and
2
International Network for the Demographic Evaluation of opportunities in our work, based on seven years practice of co‐
Populations and their Health, Ghana directoring the community.
3
University of Birmingham, UK
evelyn.anane‐sarpong@unibas.ch
HETEROLOGOUS IN VITRO FERTILISATION NOW
Surveillance and research are key evidence generating tools in
ADMITTED IN ITALY: CONSTITUTIONAL COURT’S
public health (PH). It is normal practice for PH models like health
JUDGMENT N. 162/2014 ABOLISHED THE BAN OF
and demographic surveillance systems to build upon prior
research, but whenever research seeks to involve pre‐collected INVOLVE GAMETOCYTES OUTSIDE THE COUPLE

surveillance data, higher and obligatory rules of human Pietro Ferrara
participant protections are thought necessary to ensure Second University of Naples, Italy
adherence to research ethics regulations. To our knowledge, re‐ p_ferrara@alice.it
use of surveillance data for research/publications (RUSD) is
gaining grounds, but has not been empirically investigated for In Italy, the assisted reproductive processes are regulated by Law
ethical issues. There is no clear direction on applying ethics no. 40 of 19 February 2004. It forbade the recourse to
principles to RUSD, standards for ethics review, nor the authority heterologous assisted reproductive technics; on April 9th, 2014 a
to institute ethical guidelines. We therefore hypothesize that Constitutional judges’ decision has removed this prohibition.
professionals and ethics committees muddle through existing The Law no. 40 of 2004 imposed a biological bond as prerequisite
frameworks using discretionary “good effort” extrapolations and to access to IVF programs. This clause forced lot of Italian couple
deductive analysis to define what is ethical in RUSD. Imprecise moving in other Country to go along with their parental wishes:
guideline interpretation and misapplication of principles to foreign medical travels make, in Constitutional judges’ opinion,
critical issues may arise. Waiting for the right RUSD ethical inequality (social injustice) among citizens as well as they amount
guidance to naturally evolve could be slow, and given population to great costs to both National Health Service and patients.
numbers, costly. This study uses a mixed methods approach Moreover, Constitutional Court analysed various other
involving theoretical and normative ethics literature review and assumptions: so, its judgment no. 162/2014 stated as
an empirical phase of field work in Ghana, Tanzania and Uganda. unconstitutional some sections of Law no. 40, because these
The presentation will discuss literature that tends to distinguish posed threats to parental wish and personal liberty, will and right
research from surveillance to conceptualize RUSD; examine ethics in building a family.
guidelines, regulations and laws to understand the current Consulta’s decision gave rise to heterogeneous voices coming
knowledge‐practice base on which RUSD operates, and adequacy from scientific community and from public opinion. Even though
of existing frameworks. The ultimate outcome is an ethical opposite feelings are licit – and perhaps helpful – about a such
framework that addresses unique characteristics of RUSD, offers thorny issue as assisted fertilisation process is, at the moment
straightforward guidance to researchers and ethics committees, upright bioethical considerations are necessary for regulating the
and supports health research involving use of existing data. legislative void and creating guidelines as instructed by
Constitutional Court itself, coherently to European
recommendations.
PSYCHOLOGICAL E‐VOLUNTEERING AMONG RUSSIAN
SPEAKERS
ETHICAL DECISION MAKING AND PATIENT AUTONOMY
Olga Bermant‐Polyakova VIEWS AMONG THE NURSING STAFF
Israel
office_dr_olga@mail.ru Shani Fisher1, Aya Solomon1, Michael Peker1, Akiva Nachshon2,
Naama Schwartz1,3
An ethical message is delivered to society, into the mind and into 1
Emek Medical Center, Israel
daily life and behaviour, by traditional educational and legal 2
Beth Israel Deaconess Medical Center, USA
ways. This task may be realized by a novel way of e‐volunteering. 3
University of Haifa, Israel
An online volunteer is a volunteer who completes tasks, in whole shani_fi@clalit.org.il, naama.stat@gmail.com
or in part, via Internet. Currently there is no organization tracking
the best practices in e‐volunteering, amount of people are Background: Several studies explored the attitude of doctors
engaged in online volunteering, or how many organizations towards patients' autonomy, while others examined the family's
involve online volunteers. role in patients' decision making in autonomy related manners.
When an ethical thought, moral values and principles determine Yet, only few studies investigated the nursing staffs' views on the
a construction and technique of interaction, a new format of subject of patient's autonomy.
relationship, similar to psychotherapeutic setting, comes into Objectives: We aim to explore the views of nurses, concerning
being in virtual space. This template exists in unique online the patient's autonomy and to compare the views in relation to
volunteering community "Be Your Own Shrink" on Live Journal. their ethnicity, seniority and religion.
Thousands of Russian speakers from 65 countries engage in Methods: A survey amongst nurses was preformed between May
collaborative work online that provides psychological support and July 2014. We examined the approaches to patient
and psycho‐educational help nonstop. An archive of transcripts autonomy through the attitude towards medical dilemmas
counts 19,200 group discussions, subdivided into 70 categories. represented in the form of six clinical cases and six additional
general statements (Ruhnke et al. (2000) Questionnaire). The procedure of ethical review cases when it is necessary to violate

clinical cases are designed to explore the attitude issues relating the privacy of a patient without his consent to the notification of
to patient autonomy, family involvement and the doctors' his family members are potentially exposed to the risk of disease.
authority in these cases. So the technology implementation of personalized medicine will
Results: The survey included 185 nurses. Approximately 43% of exacerbate many ethical issues in the clinic. Therefore it is
the nurses had a strong tendency towards patients' autonomy necessary to develop effective ethical and legal ways of their
with low regard towards the family and/or the doctors' authority. resolution until promising scientific developments are
A significant association was found between the nurses seniority transformed into everyday clinical practice. We believe that it is
and the tendency towards patients' autonomy (P=0.0046). necessary to supplement the Basic educational program in the
Regard for patient autonomy was higher among secular nurses specialty "medical business" and programs of post‐graduate
compared to religion ones (P=0.0368). Family authority in these training dermatologists themes for personalized medicine,
matters was considered significantly higher among Arab nurses genetic testing and pharmacokinetics, to Supplement regional
compared to Jewish nurses (P=0.0389). Doctor authority was programs of development of health issues, raise awareness of the
deemed significantly higher by senior nurses (P=0.0161). population about personalized medicine.
Conclusion: Novice nurses tend to consider the patient as the
sole authority regarding his medical decisions. Family authority
was perceived as a crucial factor by Arab and religious nurses (of THE ITALIAN INFORMATION SYSTEM FOR MONITORING
all ethnical spectrums). ERRORS IN HEALTHCARE

Luigi Tonino Marsella1, Alessandro Feola2, Valeria Marino1,
THE BIOETHICS OF COMPULSORY TREATMENT Elisabetta Bernardel3, Antonella Masullo2, Sergio De Dominicis4
1
DETERMINED BY A COURT ORDER University of Rome “Tor Vergata, Italy
2
Second University of Naples, Italy
3
Gabriel José Chittó Gauer, Anamaria Feijó, Lívia Pithan, Law Firm “Cannata & Associati”, Italy
4
Paulo Vinicius Souza Law Firm “De Dominicis”, Italy
Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), marsella.luigi@gmail.com
Brazil
gabrielgauer@gmail.com The Italian Government, through the Decree of the Ministry of
Labor, Health and Social Policies of the 11.12.2009, instituted an
Are there ever circumstances under which people should be information system for errors in Healthcare. It is agreed upon
deprived of their liberty and subjected, without their consent, to that in the healthcare environment this system of recognizing
psychiatry treatment? The Brazilian law allows people who are and signaling errors is the base for prevention and improvement
supposedly making use of psychoactive substances in a harmful of the system. In fact, in the past few years, units for clinical risk
way to be hospitalized by a court order. An important aspect to management have been created in our general hospitals.
be considered is that in this country any person may request the Nevertheless, signaling errors has always been seen as a taboo; a
hospitalization as well as it can be determined in some good example would be Ernest A Codman, one of the founders of
circumstances only by a judge decision. The judge may take the the American College of Surgeons, who was ostracized by his
decision even without an evaluation of a mental health team. colleagues for the preciseness with which he recorded damages
From the standpoint of bioethics here, we have a dilemma that caused to the patients by surgery. Security for patients and
mainly involves the principles of beneficence and autonomy. clinical risk management are critical points for all clinical systems,
Principles which should always be considered in situations where in fact, the complexity of the clinical organizations, the high level
there is a disagreement between what a health professionals or of technology and the increased amount of services provided are
others disagree with the patient decision. We also should intrinsic factors of the system and can increase the possibility of
consider that such kind of treatment although very beneficial for errors occurring with adverse consequences for the patients. It is
some, will not be of any help for a few, only partially effective for evident that error and the possibility of an incident can’t be fully
many, and may even harm some of them. In this paper, we will eliminated, but all possible measures must be taken so that they
address the issue focus based on a principialist point of view and can be controlled, and most of all, reduced to a minimum.
analyzing situations where there were a court order for Since in Italy there is a regionalization (devolution) of the
hospitalization without the patient consent. National Healthcare System that becomes the Regional
Healthcare System, which as a consequence each Region must
set forth the laws issued by the National Legislator, the Authors
DERMATOLOGICAL ETHICAL PROBLEMS OF will discuss the implementation of the Information System for
PERSONALIZED MEDICINE monitoring errors in Healthcare in the Lazio Region.

Irina Krainova
Volgograd State Medical University, Russia LAWSUITS RELATED TO THE HEALTH IN BRAZIL – A TRULY
beautydoctor@inbox.ru “FACTORY” OF INDEMNIFICATION FOR MORAL DAMAGES

As personalized medicine is based on a genetic typing of patients, Paulo de Argollo Mendes, Maria Rita de Assis Brasil, Vitor Dossa,
its development actualizes the bioethical problems of genetic Diego Baisch
technologies, caused by the special nature of genetic information. SIMERS – Medical Trade Union of Rio Grande do Sul, Brazil
Population survey and interviews with the patients presidencia@simers.org.br
dermatological practice evidences of high significance for them
confidentiality of genetic information, only a tenth of the In the past 10 years the lawsuits related to the health area have
population is indifferent to the principle of confidentiality. The increased more than 200%, reaching the record level of 241
special nature of genetic information produces another ethical thousand claims in Brazil. The State of Rio Grande do Sul alone
dilemma: the conflict between principle of respect for autonomy accounts for almost half of the Brazilian legal cases, being the
and principle of «do no harm». It’s important to develop the state with the far most lawsuits involving health in the country.
Abstracts of Poster Presentations 91
Data show that about 10% of these lawsuits are related to the demands that the case of organ sales be reconsidered, this article
alleged medical error, or malpractice, which would be considered a variety of proposed options with specific focus on
somewhere around 24,100 cases in Brazil, and 12,050 in the the legalisation of compensated live kidney transplantation.
State of Rio Grande do Sul alone. Whilst this debate has been discussed for many years amongst
It is known that the growing number of lawsuits, in the health ethical scholars the article sought to review the arguments
area, in Brazil is due to the fact of the existence of free justice presented in the current literature and challenge them against
that allows access to the judiciary to all citizens who have low/ the context of today’s social and ethical beliefs and within an
non financial capability, by not making any form of collection, evolving healthcare system that increasingly recognises the
creating, therefore, a truly “factory” of indemnification for moral importance of patient autonomy. Topics discussed include; 1)
damages. fair re‐imbursement 2) patient and donor autonomy 3) the
As a consequence, the natural flow of the indemnification cases current sale of bodily materials 4) exploitation 5) regulation and
are not followed, since only 7% of the Physicians sued for 6) the threat to personhood in the presence of bodily
malpractice, will be also facing ethical charges in the regulatory commodification.
professional committee. The author established that the arguments against organ sales do
Compensation industry weakens the country's health system, not stand up strongly to scrutiny suggesting that the sale of
particularly in the State of Rio Grande do Sul, and threats the kidneys is an ethically acceptable practice. In the presence of
Physicians, preventing them, in many cases, from using more numerous logistical hurdles such practice needs comprehensive
appropriate, or more invasive, treatments, since they are afraid and sensitive consideration by legal, clinical and ethical
of facing legal cases. healthcare teams.

BEHAVIOURAL SUBJECTS IN THE PUBLIC HEALTH STUDIES: ETHICAL ISSUES IN PAEDIATRIC PHYSIOTHERAPY
HISTORIC PARALLELS AND MODERN ALTERNATIVES PRACTICE: A SURVEY OF PHYSIOTHERAPISTS IN GHANA

Vanina Michaylova1,2, Mariana Lyochkova1,2, Bertha Oppong‐Yeboah, Caleb Andoh, Gifty Nyante
Maria Semerdzhieva1,2, Adolf Alakidi1 University of Ghana, Ghana
1
Medical University – Sofia, Bulgaria boppong_yeboah@chs.edu.gh
2
Medical University – Plovdiv, Bulgaria
Vanina_delfi@abv.bg Background: Paediatric physiotherapists work with one of the
most vulnerable populations. Majority of their clients are
Our attention is focused on two essential subjects from the area children with neurological and cognitive deficits which may likely
of behavioural science that are taught in higher medical schools, present complex ethical dilemmas. Worldwide there are a few
namely medical ethics and health promotion. We make a brief studies that focus on ethical issues in paediatric physiotherapy. In
historic overview of the introduction and evolution of these Ghana however such research is nonexistent.
subjects that we refer to as ‘the Plovdiv model’ and as the Objective: This study is the first of several that seeks to explore
experience of the Medical University, in particular of the Faculty the peculiar ethical issues in physiotherapy practice in Ghana.
of Public Health. While preserving the particularities of their This first study focuses on therapists who are involved in the
respective content, as concepts they include number of common rehabilitation of children.
aspects that contribute to the behavioural and management turn Methods: All physiotherapists who have worked for at least a
of mind of health care officers. year in the paediatric unit of five hospitals in Ghana will be
Among other factors, the exceptional interest shown by students recruited to participate in the survey. A questionnaire of thirty
caused an essential transformation consisting at present of: items that describe situations suggestive of ethical problems
upgrade and penetration of medical ethics in the wider developed by Andrew Guccione will be modified for use in this
theoretical and research field of global philosophic and ethical survey. The tool requires respondents to score items according to
issues of bioethics; achieving an unusual symbiosis between the the frequency with which they had encountered a situation of
fundamentally applied level of bioethics and the specific area of the type described in their own professional practice and the
business relationships in the business environment; introduction difficulty they experienced in reaching a decision in those
of the salutogenic approach as counterpoint to the modern instances. Additional data on respondent’s demographics and
epidemiology and the pathogenic approach as a launch point for client factors that influence these ethical situations will be
a paradigm change in preventive medicine and health promotion. collected.
Expected outcome: Data would aid a first descriptive mapping of
the ethical issues paediatric physiotherapist face and how they
THE WAITING GAME: IS IT TIME TO CHANGE THE RULES? deal with them. It would also highlight demographic factors of
AN ETHICAL PROPOSAL TO LEGALISE A REGULATED the therapists and patients that influence the frequency of
SYSTEM OF KIDNEY SALES occurrence of such ethical situations and how they are handled.

Erica Morris
Leeds Teaching Hospitals, UK E‐HEALTH: THE NECESSARY BALANCE BETWEEN
Erica.morris@doctors.org.uk EFFECTIVENESS OF THE HEALTH SYSTEM AND

The current system of kidney procurement and rationing is PROTECTION OF FUNDAMENTAL RIGHTS

inadequate, both in the UK and on a global scale. For the past María Magnolia Pardo‐López
four decades attempts to bridge the ever‐increasing gap between University of Murcia, Spain
the supply and demand of kidneys have failed hence the lives of magnolia@um.es
those on waiting lists continue to be put at risk. There is now a
medical and social responsibility to consider new options to In general terms, e‐Administration is (or might be) the future of
address the growing problem of organ shortages. Whilst the Public Administration and this happens to be true (or should be)
report from the International Forum for Transplant Ethics also when it comes to talk about the Health System run by public
powers. This poses many challenges for jurists used to traditional January 8, 1901. Son of a mechanic, Sannwald won a scholarship
methods well known to them and not always aware of the ever to prepare for a career in theology when he was fourteen years
increasing possibilities (and dangers, why not say so) offered by old and in 1923 was ordained a Lutheran minister. In 1924 ‐1925,
new technologies. he was a visiting fellow at the Divinity School at Harvard. After
Technology embodies an “opportunity to improve health” in two this experience he came back to Germany, teaching at Tubingen
different ways. First of all, it offers a direct chance to enhance University where he met Anna von Sehrwald, the woman he
Medicine by bettering medical diagnosis, interventions and married. In 1930, he became the pastor of St Mark's church in
treatments. It also provides the adequate means to administer in Stuttgart. In 1931, preaching one of his sermons, he angered
a much more effective and efficient way the scare human and local National Socialists. Adolf Sannwald belonged to the
economic resources in order to satisfy the right to health Confessing Church formed in opposition to Hitler's German
recognized in Constitutions and Statutes. Christian Church. In 1934, he wrote a pamphlet "Why not
Information is the key to the modern Health Systems, mainly German Christians?"(available on http://sannwald.org/page4.html)
information about patients. Nevertheless, in managing and where he wrote: " God does not choose his children on the basis
processing such pieces of information called data many risks of race". After the "Jew‐lover" graffiti on his house, he was
arise. Data protection and privacy of the patients ought to be threatened with being banned from speaking publicly by the
carefully protected without hindering public health, medical authorities. In 1936, after several warnings by the Gestapo to
research or any other general interest that deserves to be take him to jail, he moved with his wife and daughters to
secured. Dornhan in the German Black Forest. Here his rectory became a
In our paper we intend to analyze this second aspect since it is haven for fugitive Jews on their way to France. No one of the
closely related to the proper protection of fundamental rights family knew their names in order to prevent the children from
public powers are committed to. Special attention to the Spanish accidently commenting on their “visit”. Sannwald, moreover,
Public Health System will be paid. Nowadays that the European pressed the local Nazi leader about the disappearance of
Union is going through the complete review of its legal norms detainees in Poland. He always refused to follow the Nazi party.
regulating personal data protection as well as the As a result, in January 1942, Sannwald was drafted into the
implementation of Directive on Public Sector Information Reuse Wehrmacht as a common soldier, not a chaplain, and was sent to
is being carried out by Member States, it may be a good moment the Russian border where he served at first on the front as
to comment the scare specific mentions to health data in general soldier, and then as a cook's helper, a janitor and a clerk, after his
terms and make proposals in the sense of balancing the fifth child was born. After 18 months he was killed in an air raid,
protection of these fundamental rights (data protection and on June 3, 1943. “Sannwald died a soldier in the army of a regime
privacy, mainly) and the general interests involved. he despised; he was indeed an enemy casualty.”
Don’t let prejudice influence us, don’t judge by appearances: let
the search for truth always be our goal.
ADOLF SANNWALD – ENEMY CASUALTY
HOW A NOTATION CAN TURN THE WORTH OF A GERMAN
PASTOR INTO THE WICKEDNESS OF A NAZI EVIL MITOCHONDRIAL REPLACEMENT THERAPY AND
PARENTHOOD
Alessandra Pentone
European Centre for Bioethics and Quality of Life – UNESCO Chair Daniel Sperling
in Bioethics Italian Unit, Italy The Hebrew University of Jerusalem, Israel
alesspent@libero.it daniel.sperling@mail.huji.ac.il

The World War II memorial in the chapel at Harvard University 2014 will be a decisive year for the future of Mitochondrial
pays tribute to the Harvard students that were killed during the Replacement Therapy (MRT) –at least in the Western world.
war. Included in this tribute is Adolf Sannwald with the notation Currently, the UK and the US governments are undergoing a
"Enemy Casualty" following his name. This notation has created process of ethical and scientific evaluation of the technique to
considerable interest over the years as well a much speculation. decide whether to allow its implementation or not. MRT requires
Wonder and/or anger could be the feeling of the typical visitor the fusion of the DNA of three parents (although of a minimal
presuming that the name of a soldier in Hitler’s army was percentage in the case of one of the two female genitors) into an
included on a Memorial. Such feelings are only the after‐math of embryo –and this creates a number of worries for what this
the controversy that took place in 1951 when the Harvard scientific innovation will lead to. These worries might be well
student newspaper opined “whatever Sannwald’s motives for placed and worth of consideration, but not on the grounds that
fighting in the Nazi cause, it is obvious he was not defending in some opponents bring forward. In this paper, we will analysis a
any way the principles that had nourished Harvard.” The outrage recent EU petition that urges the UK government (but could be
of some alumni and veterans induced the University’s governing applied to the US well) to refrain from legalizing MRT, to stress
board to promise that Adolph Sannwald’s name would be that other techniques such as Preimplantation Genetic Diagnosis
expunged—but it never has been. For whatever reason the (PGD) already accept a more direct eugenic potential than MRT.
German name was not removed. The debate died. But the Our conclusion is that what seems to be really at stake instead, is
doubts about Adolf Sannwald’s life and morality once raised still whether or not we are willing to reconceptualise the notion of
remain and have not been extinguished. parenthood as something not necessarily binominal and
Adolf Karl Sannwald was a German Lutheran pastor born on genetically‐related.

Authors Index
Abbasova, A ......................................... 19 Ciroma, FL ........................................... 27 Gilat, I .................................................. 36

Abdulrazak, A ....................................... 27 Cohen, MJ ........................................... 34 Gilbar, R ............................................... 36
Abramson, R ........................................ 19 Cohen‐Rappaport, G ........................... 43 Giorgi, I ................................................ 58
Abu Saraa, E ......................................... 50 Cohen‐Zubary, N ................................. 62 Gith, E .................................................. 36
Adiri, F .................................. 19,27,41,56 Colinet, S ............................................. 27 Glick, SM ........................................ 37,66
Adler, E ................................................ 50 Collins, K.............................................. 27 Glover‐Thomas, N ............................... 37
Aggarwal, G ......................................... 69 Cope‐Yossef, Y .................................... 27 Gopfert, A ............................................ 75
Ahaddour, C ......................................... 24 Copperman, Y ..................................... 28 Gordon, M ........................................... 37
Aharon, Y ............................................. 26 Goshen, E .................................. 26,37,42
Akselrod, D .......................................... 66 D’Souza, R ...................................... 22,31 Greenbaum, D ..................................... 38
Alakbarov, A ........................................ 19 Daniels, S ............................................. 28 Greenberg, R ....................................... 40
Alakidi, A .............................................. 91 Darling, MJT ........................................ 28 Greenberger, C .................................... 38
Alichniewicz, A ..................................... 20 David, C ............................................... 28 Guerra Filho, WS ................................. 70
Aliyeva, A ............................................. 20 Davidow, Z .......................................... 28 Gulma, B .............................................. 19
Aliyeva, F ............................................. 20 Davtyan, S ........................................... 29 Gur‐Arie, H .......................................... 40
Aloni, R ................................................ 40 Dawson, A ........................................... 89
Altarescu, G ......................................... 78 Dayan, I ............................................... 29 Haberer, J ............................................ 33
Alvarez Argaluza, MI ............................ 75 de Assis Brasil, MR .............................. 90 Haddad, E ............................................ 26
Anane‐Sarpong, E ................................ 89 De Dominicis, S ................................... 90 Haimov‐Kochman, R ............................ 38
Andoh, C .............................................. 91 Deau, X ................................................ 29 Hale, M ................................................ 74
Antão, AC ............................................. 70 DeBaets, A ........................................... 30 Halevy, J .............................................. 39
Aparisi, A.............................................. 20 Dejavsarov, S ....................................... 30 Halpin, R .............................................. 39
Apinis, P ............................................... 21 Dekel, R ............................................... 30 Hamiti, M ............................................ 39
Aroni, R ................................................ 21 Devor, M ............................................. 30 Handelman, M..................................... 40
Asman, O ............................................. 22 Di Salvo, I ............................................ 75 Hcohen, A ............................................ 38
Avard, D ............................................... 61 Dickman, N .......................................... 23 Hellmann, J .......................................... 40
Avidime, OM ........................................ 27 Ding, C ................................................. 31 Heresco‐Levy, U .................................. 29
Dinnen, A ............................................ 31 Heruti, R .............................................. 40
Baeke, G............................................... 24 Djuari, L ............................................... 79 Heyd, D ................................................ 38
Baisch, D .............................................. 90 Doležal, T ............................................ 31 Hildesheimer, G ................................... 40
Balakrishnan, D ............................... 22,71 Donika, A ............................................. 31 Hogemann, ERS ................................... 70
Baliga, MS ............................................ 58 Dossa, V .............................................. 90 Honeyman, P .................................. 40,63
Baramidze, L ........................................ 77 Duan, L ........................................... 32,41 Hornung, T .......................................... 75
Barbosa, C ............................................ 22 Huang, SBQ ............................... 26,32,41
Bard, TR ............................................... 22 Eagan Chamberlin, SM ........................ 32
Barghil, M ............................................ 75 Efrati, C ............................................... 32 Ianakieva, A ......................................... 73
Barilan, YM .......................................... 23 Eidelman, L .......................................... 32 Innamorato, L ...................................... 59
Barreto Leite, LOF ................................ 70 Eilati, R ................................................ 75 Introna, F ............................................. 59
Basuki, S ............................................... 62 Eisenberg, E ........................................ 33 Irony, A ................................................ 30
Bazigov, M ........................................... 19 Eisenman, E ......................................... 38
Be'eri, E ................................................ 23 Elger, BS .............................................. 89 Jacobowsky, E ..................................... 75
Ben Nun, A ........................................... 43 Eliaz, R ................................................. 34 Jaffe, E ................................................. 44
Bentwich, M ........................................ 23 Eyal, H ................................................. 38 Jain, A .................................................. 41
Benyakar, M ................................... 23,52 Eyal, N ................................................. 33 Jain, R .................................................. 41
Ben‐Yona, R ......................................... 66 Jarman, OA .......................................... 56
Ben‐Yosef, O ........................................ 75 Fadlon, J .............................................. 43 Joggy, A ............................................... 58
Berent, I ............................................... 23 Feijó, A ................................................ 90 Joshua, IA ........................ 19,41,50,56,57
Bermant‐Polyakova, O ......................... 89 Feola, A ............................................... 90 Jotkowitz, A .................................... 41,66
Bernardel, E ......................................... 90 Ferrara, P ............................................ 89 Jovanovska, S ...................................... 42
Blachar, Y ............................................. 44 Ferrara, SD .......................................... 33
Borow, M ........................................ 24,32 Feuer, J ................................................ 34 Kana, MA ........................................ 27,57
Botbol Baum, M ................................... 24 Finkelstein, Y ....................................... 63 Kannai, R ............................................. 42
Brezis, M ......................................... 24,34 Fisher, S ............................................... 89 Karni, T ................................. 26,37,42,43
Brit, L ................................................... 50 Fleisig, D .............................................. 43 Karnieli‐Miller, O ................................. 43
Broeckaert, B ....................................... 24 Flescher, D .......................................... 34 Katz Peled, T ........................................ 43
Frankel, M ........................................... 34 Katz, Y .................................................. 43
Cambra Badii, I .................................... 23 Frischhut, M ........................................ 34 Katzav, M............................................. 75
Campbell, J .......................................... 33 Katzenelson, E ................................ 43,44
Cannaviello, C ...................................... 32 Gambheera, H ..................................... 35 Keidar, D .............................................. 44
Cekić, N ................................................ 25 Ganguly, B ........................................... 35 Keren, A ............................................... 48
Chavdarovski, P ................................... 73 Gao, S ............................................ 26,35, Khalaila, R
41 ............................................ 44
Chelouche, T ........................................ 25 Garasic, MD......................................... 35 Kim, C .................................................. 40
Chemtob, D .......................................... 26 Garba, ES ............................................. 50 Klein, Z ................................................. 53
Chen, B ...................................... 26,37,42 Garcia, A .............................................. 36 Knobler, HY ......................................... 44
Chen, WWB .................................... 26,35 Gauer, GJC .......................................... 90 Knoppers, BM ...................................... 61
Chung, Y ............................................... 26 Ghazaryan, K ....................................... 29 Koren, D .............................................. 28
Cicovacki, P .......................................... 49 Giardini, A ........................................... 58 Kostenzer, J ......................................... 45
Index 95
Kottek, S .............................................. 45 Moran, U ............................................. 54 Rahimzadeh, V ..................................... 61

Krainova, I ........................................... 90 Moreno, A ........................................... 54 Rahmatullah, I ................................ 62,79
Kubar, OI ............................................. 52 Morris, E .............................................. 91 Rakic, V ................................................ 62
Kukubajska, ME ................................... 45 Moskowitz, JM .................................... 69 Rappaport, ZH ..................................... 62
Kumar, A ............................................. 58 Muhammad‐Idris, Z ................... 41,56,57 Rehatta, NM ........................................ 62
Kuře, J ................................................. 46 Mullen, M ............................................ 55 Reicher‐Atir, R ..................................... 62
Kurosu, M............................................ 46 Muratova, MM .................................... 56 Richter, E ............................................. 63
Musa, AK ............................................. 76 Roditis, K .............................................. 75
Lahat, Y ............................................... 34 Musiimenta, A ..................................... 33 Rosenbaum, T ...................................... 40
Lamoure, J ........................................... 46 Myburgh, CPH ..................................... 55 Rosenblum, I ........................................ 63
Langham, F .......................................... 75 Roth, B ................................................. 63
Laufer, N ............................................. 38 Nachshon, A ........................................ 89 Rubinow, A ..................................... 34,63
Laufer‐Ukeles, P .................................. 46 Nagesh, KR .......................................... 41 Rubinstein, A ....................................... 64
Le Xuan, T ............................................ 47 Nagib, M .............................................. 70 Rubinstein, D ....................................... 68
Lederman, Z ........................................ 47 Naimer, SA .......................................... 55 Rubinstein, E ........................................ 26
Lepicard, E ........................................... 47 Neitzke, G ............................................ 73
Letendre, MC ...................................... 47 Ngole, ME ............................................ 69 Sada, MN ............................................. 27
Lev, O .................................................. 48 Nikitina, AE .......................................... 52 Sagun, RD ............................................ 64
Leviani, R ............................................. 48 Niv‐Yagoda, A ...................................... 43 Salton, A .............................................. 26
Levy, M................................................ 48 Nmadu, AG ........................... 19,41,56,57 Samama, E ........................................... 64
Li, KR ................................................... 35 Noguchi, T ........................................... 56 Sándor, J .............................................. 65
Li, Z ........................ 26,32,35,41,48,49,74 Noles Cotito, G .................................... 75 Sani, YB ................................................ 58
Liang, H .......................................... 35,49 Novais da Silva, M ............................... 70 Sankoh, O ............................................ 89
Lifshitz‐Aviram, P ................................ 49 Nyante, G ............................................ 91 Santori, P ............................................. 65
Lima, NS .............................................. 49 Saravanan, S ........................................ 65
Liu, K .............................................. 26,32 Oberman, A ......................................... 23 Savic Vujovic, K .................................... 61
Liu, X ................................................... 49 Obradovic, D........................................ 61 Scharff, C ............................................. 65
Low, TH ............................................... 49 Ochkur, OK .......................................... 56 Schuz, R ............................................... 66
Lumadi, TG .......................................... 50 Ohry, A ................................................ 57 Schwartz, N .......................................... 89
Lupton, M ........................................... 50 Oliveira, P ............................................ 57 Scolnik, D ............................................. 40
Lyochkova, M ...................................... 91 Omole, VN ...................................... 57,76 Sedova, N ............................................. 66
Onyemocho, A ................................ 41,56 Segal‐Reich, M ..................................... 66
Ma, HD ................................................ 49 Oppong‐Yeboah, B .............................. 91 Sela, L .................................................. 28
Maaravi, Y ........................................... 50 Oron, I ................................................. 57 Semerdzhieva, M ................................. 91
Makama, JG ................................... 41,50 Ottonello, M ........................................ 58 Sénécal, K ............................................ 61
Malul, L ............................................... 51 Oyefabi, A ............................................ 58 Shack, AR ............................................. 66
Mammadov, I ...................................... 19 Shalev, C .............................................. 67
Mammadov, V .................................... 19 Pain, D ................................................. 58 Shalmon, E ........................................... 67
Marcus, EL ........................................... 29 Palatty, PL ....................................... 41,58 Shaulov, A ............................................ 34
Margalit, Y ........................................... 51 Pardo‐López, MM ........................... 59,91 Shenoy, R ............................................. 41
Margolin, J .......................................... 51 Pariani, S......................................... 59,79 Shir‐Raz, Y ............................................ 67
Marino, V ............................................ 90 Pasetti, C ............................................. 58 Siebzehner, MI ..................................... 68
Markova, K .......................................... 60 Peker, M .............................................. 89 Silva de Oliveira, HC ............................. 70
Marsella, LT ......................................... 90 Pentone, A ................................. 59,73,92 Singh, RR .............................................. 68
Martins, D ........................................... 75 Pereira, I .............................................. 75 Sinnett, D ............................................. 61
Mashiah, S........................................... 38 Peretz, E .............................................. 38 Smerling‐Kerem, J ................................ 68
Masullo, A ........................................... 90 Peri, T .................................................. 28 Sokolowski, M ..................................... 68
Mathew, M ......................................... 41 Perry, W .............................................. 75 Solomon, A .......................................... 89
Mattar, C ............................................. 75 Perry‐Mezare, H .................................. 34 Sotirova, D ........................................... 69
Medic, B .............................................. 61 Pétrin‐Desrosiers, C ............................. 75 Souza, PV ............................................. 90
Menasheoff, L ..................................... 75 Piazza o Sed, N .................................... 32 Sperling, D ...................................... 69,92
Mendes, PDA ...................................... 90 PiIleggi, T ............................................. 63 Sprung, CL ............................................ 34
Mester, R ............................................ 51 Pinchenkova, LA .................................. 52 Srebro, D .............................................. 61
Michałowska, M .................................. 20 Pithan, L .............................................. 90 Stein, Y ................................................. 69
Michaylova, V ..................................... 91 Poggenpoel, M .................................... 55 Stojanovic, R ........................................ 61
Michel Fariña, JJ ............................. 23,52 Pollard, I .............................................. 60 Stolte, H ............................................... 40
Mikirtichian, GL ................................... 52 Popova, K ............................................ 60 Stopic, B ............................................... 61
Milikovsky, DZ ..................................... 66 Popova, S ............................................. 60 Strozenberg, F ..................................... 70
Milinkovic, I ......................................... 52 Poster, MF ........................................... 60 Su, ZM .................................................. 32
Miller, J ............................................... 47 Prajitno, S ............................................ 79
Mimoni, Z ............................................ 38 Prajwith ............................................... 58 Tadmor, B ............................................ 62
Miola, J ................................................ 36 Pranoto, A ........................................... 79 Tal, M ................................................... 70
Miranda, M ......................................... 52 Prokopiou, A ........................................ 60 Tanner, M ............................................ 89
Mishori, D ........................................... 53 Prostran, M ......................................... 61 Tewel, C ............................................... 70
Mital, AK ............................................. 53 Protić, D ............................................... 71 Tham, J ................................................ 70
Miteva, I .............................................. 53 Thangaraju, P .................................. 22,71
Moleki, MM ........................................ 54 Quitz, A ................................................ 61 Thorne, E ............................................. 71
Tilinger, Y ............................................. 54 White, BP ............................................ 74 83 .............................................. ‫ש‬ ,‫אוחנה‬

Toader, E .............................................. 71 Wikler, D ............................................. 33 83 .................................... ‫מ‬ ,‫גביזון‬ ‫אלבוים‬
Todorović, Z ......................................... 71 Wiley, E ............................................... 75 83 ............................................... ‫מ‬ ,‫נתן‬ ‫בן‬
Treger, I ............................................... 72 Wilson, D ............................................. 75 83 ................................................ ‫ד‬ ,‫נוי‬ ‫בר‬
Trigueiro Santos Adinolfi, V ................. 72 Wohlgelernter, S ................................. 75 84 ............................................. ‫מח‬ ,‫ברייר‬
Tsai, DFC .............................................. 72 Wolf, R ................................................ 76 84 ................................................ ‫צ‬ ,‫בר‐נוי‬
Tun, W ................................................. 75 Wolfman, S ......................................... 76 84 .......................................... ‫ח‬ ,‫גרינברגר‬
Turkenich, S ......................................... 62 84 .............................................. ‫ס‬ ,‫דומבה‬
Yahalom, R .......................................... 34 85 ................................................... ‫נ‬ ,‫וגנר‬
Van den Branden, S ............................. 24 Yang, J ................................................. 49 84 .................................................. ‫נ‬ ,‫טבק‬
Vasinova, M ......................................... 73 Yust, I .................................................. 26 85 .............................................. ‫ע‬ ,‫ליברטי‬
Veselska, R ........................................... 73 Yusuf, MS ....................................... 27,76 84 ............................................ ‫ס‬ ,‫מלניקוב‬
Veshi, D ................................................ 73 85 ............................................... ‫ש‬ ,‫ניסים‬
Vilk, S ................................................... 38 Zakariadze, A ....................................... 77 85 ................................................ ‫מ‬ ,‫פייזר‬
Vodenicharov, V .................................. 73 Zaki, M ................................................ 77 85 .................................................. ‫א‬ ,‫קורן‬
Vodenicharova, A ................................ 73 Zarnadze, I .......................................... 77 84 ........................................... ‫ש‬ ,‫קרייטלר‬
Vozzella Hall, D .................................... 75 Zarnadze, S .......................................... 77 85 ......................................... ‫ד‬ ,‫רובינשטיין‬
Vuckovic, S ........................................... 61 Zhang, R ......................................... 48,74 86 .................................................... ‫ח‬ ,‫רז‬
Zilberstein, I ........................................ 78
Waitzman, R ........................................ 74 Zimmerman, DR .................................. 78
Walker, X ............................................. 75 Ziv, A ................................................... 34
Wang, C .......................................... 48,74 Zlotnik Shaul, R ................................... 40
Wangmo, T .......................................... 89 Zuckerman, S ...................................... 78
Wapner, L ....................................... 24,32 Zur‐dovrat, L ....................................... 62
Wei, T ................................... 26,32,35,41 Zuscinova, J ......................................... 79
Werner‐Felmayer, G ............................ 74

Bioethics, Medical Ethics and Health Law: Program and Book of Abstracts

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UNESCO Chair in Bioethics 10th World Conference on

Bioethics, Medical Ethics

Program and Book of Abstracts

ISAS International Seminars • POB 574, Jerusalem, Israel • Tel: +972-2-6520574

Message from the Conference President 5

Call for Establishment of New Bioethics Units 6

UNESCO Chair in Bioethics – International Forum of Teachers 8

Abstracts (alphabetical order by author)

Organizing Committee Scientific Committee

Prof. Amnon Carmi

A Call for the Establishment

UNESCO Chair in Bioethics

Chair: D. Flescher Chair: Y. Blachar Chair: J. Lamoure Chair: S. Wolfman Chair: T. Doležal

To be or not to be a live "reality TV" review board (IRB) or The evolution of the abort a viable fetus

Vaccination of health any clinical activity? Overview of the US

Political hunger Ethical dilemma in the use of benevolence

health services in Indonesia Individual patient rights

rules: Implications for functional disability and during the Indigenous The ethical challenges of guardianships in medical

professional activities ubiquitous use of smart anthropological view Psychological aspects of

A paternity case with methods to inculcate Comparing two New Zealand The role of the Israeli

and bioethics through Ethics & professionalism: Daniella Keidar, Israel

Yael Stein, Israel Promoting bioethics in Belgian Muslims and Tung Le Xuan, UK Development of patient

Children in armed Philippines comparison Defending “Big Brother

Chair: M. Ottonello Chair: D. Sperling Chair: D. Chemtob Chair: N. Salomé Lima ‫ נילי טבק‬:‫יו"ר‬

mental first aid bioethics and Pain, consciousness and

constitute universal bioethical values. Their implementation authors of their own history”. Secondly, we present the narrative

Conference promoted development of bioethics in Azerbaijan, F. Aliyeva, A. Aliyeva

sustainable and human perspective as masterly demonstrated in conditions and co‐morbidity. It offers better accessibility to

differing cultural perspectives, while not comprising the ethical cases. Emphasis will be placed on differentiating these programs

category, approx. 60 relevant documents have been identified, THE STUDY OF THE NATIONAL CUSTOMS IN FORENSIC

public, remains a shadowy authority unrelated to more direct Mentor Hamiti

Method: A qualitative phenomenological hermeneutic and Adi Moreno

conspicuous (3rd year median value ‐ 3, interquartile range 3‐4; Background: Progress in understanding childhood disease using

not the stock‐in‐trade of medical professionals or typical homosexuality, etc. are signs of such self‐preservation behavior.

Convention on Protection of Children and Co‐operation in Meytal Segal‐Reich

function of ethics committees, government agencies and other Valeria Trigueiro Santos Adinolfi

Introduction: Development of Patient Rights and Legislation

‫טעויות בטיפול והסיעוד‬ ‫אוכלוסיית המחקר – ‪ 359‬אחיות )‪ 79%‬נשים( העובדות במסגרות‬

general statements (Ruhnke et al. (2000) Questionnaire). The procedure of ethical review cases when it is necessary to violate

Abbasova, A ......................................... 19 Ciroma, FL ........................................... 27 Gilat, I .................................................. 36

Kottek, S .............................................. 45 Moran, U ............................................. 54 Rahimzadeh, V ..................................... 61

Tilinger, Y ............................................. 54 White, BP ............................................ 74 83 .............................................. ‫ש‬ ,‫אוחנה‬

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