The authors review the historical use of medicinal cannabis and discuss the agent's pharmacology and pharmacokinetics, select evidence on medicinal uses, and the implications of evolving regulations on the acute care hospital setting.

Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting.

Background: The provision of psychotherapy over distance using technology is a growing market reaching many patients and therefore the risks and benefits need to be known by all psychotherapists whether they themselves practice online or not. This comprehensive review of the main ethical arguments for and against different forms of online psychotherapy aims to enhance discussion of ethical issues in this growing area. Methods: A search of three databases (PubMed, PsycINFO, Web of Science) was conducted in August 2019 using a specific search protocol yielding 249 publications. Results: Of 24 ethical arguments in favor of online psychotherapy and 32 against, the top five ethical arguments in favor of online psychotherapy were (1) increased access to psychotherapy and service availability and flexibility; (2) therapy benefits and enhanced communication; (3) advantages related to specific client characteristics (e.g., remote location); (4) convenience, satisfaction, acceptance and increased demand; and (5) economic advantages. The top five ethical arguments against engagement in online psychotherapy were (1) privacy, confidentiality and security issues; (2) therapist competence and need for special training; (3) communication issues specific to technology; (4) research gaps; and (5) emergency issues. Conclusions: The findings may be of help to practitioners in deciding whether to engage in online psychotherapy, and in informing patients about risks and benefits, improving ethical guidelines, and stimulating further ethical discussion. The findings are argumentative and qualitative in nature, and further quantitative research is needed.

/pdf/ethical-issues-in-online-psychotherapy-a-narrative-review-k6b8q50fvw.pdf

Ethical Issues in Online Psychotherapy: A Narrative Review.

Background: The advent of telemedicine has allowed physicians to deliver medical treatment to patients from a distance. Mobile apps such as WhatsApp Messenger, an instant messaging service, came as a novel concept in all fields of social life, including medicine. The use of instant messaging services has been shown to improve communication within medical teams by providing means for quick teleconsultation, information sharing, and starting treatment as soon as possible. Objective: The aim of this study was to perform a comprehensive systematic review of present literature on the use of the WhatsApp Messenger app as an adjunctive health care tool for medical doctors. Methods: Searches were performed in PubMed, EMBASE, and the Cochrane Library using the term “whatsapp*” in articles published before January 2016. A bibliography of all relevant original articles that used the WhatsApp Messenger app was created. The level of evidence of each study was determined according to the Oxford Levels of Evidence ranking system produced by the Oxford Centre for Evidence-Based Medicine. The impact and the indications of WhatsApp Messenger are discussed in order to understand the extent to which this app currently functions as an adjunctive tool for telemedicine. Results: The database search identified a total of 30 studies in which the term “whatsapp*” was used. Each article’s list of references was evaluated item-by-item. After literature reviews, letters to the editor, and low-quality studies were excluded, a total of 10 studies were found to be eligible for inclusion. Of these studies, 9 had been published in the English language and 1 had been published in Spanish. Five were published by medical doctors. Conclusions: The pooled data presents compelling evidence that the WhatsApp Messenger app is a promising system, whether used as a communication tool between health care professionals, as a means of communication between health care professionals and the general public, or as a learning tool for providing health care information to professionals or to the general population. However, high-quality and properly evaluated research is needed, as are improvements in descriptions of the methodology and the study processes. These improvements will allow WhatsApp Messenger to be categorically defined as an effective telemedicine tool in many different fields of health care.

WhatsApp Messenger as an Adjunctive Tool for Telemedicine: An Overview

Given the profound influence of social media and emerging evidence of its effects on human behavior and health, bioethicists have an important role to play in the development of professional standards of conduct for health professionals using social media and in the design of online systems themselves. In short, social media is a bioethics issue that has serious implications for medical practice, research, and public health. Here, we inventory several ethical issues across four areas at the intersection of social media and health: the impact of social networking sites on the doctor-patient relationship, the development of e-health platforms to deliver care, the use of online data and algorithms to inform health research, and the broader public health consequences of widespread social media use. In doing so, we review discussions of these topics and emphasize the need for bioethics to focus more deeply on the ways online technology platforms are designed and implemented. We argue that bioethicists should turn their attention to the ways in which consumer engagement, bias, and profit maximization shape online content and, consequently, human behavior and health. We also offer a set of recommendations and suggest future directions for addressing ethical challenges in these domains.

Social Media, E-Health, and Medical Ethics.

Opioid Use Disorders.

Medical tourism is a vastly growing medical phenomenon in which patients from around the world travel internationally in search of inexpensive and quick, medical procedures. These economically driven treatments can be as different as plastic cosmetic surgery to fertility treatments. The one aspect that they have in common is the poor quality of treatment and care some hospitals and clinics offer to patients. Medical tourism is risky at best with many aspects of the process lacking monitoring or standardization. The surgical procedures are often medically unsafe, illegal and could be considered unethical. Without a doubt, medical tourism is a growing and very critical public health concern. Despite the many risks, however, medical tourism is a thriving industry: 6 million US citizens alone continue to travel globally into the medical tourism phenomenon. India has become the center for medical tourism over the last 5 years. India is specifically known in field for its specialties in cardiovascular, neurology/spine, orthopedic, oncology and weight loss surgeries. Due to the income it has accumulated from the paying tourists, India is not only expanding in medical tourism, but other countries are imitating their medical entrepreneurship, adding to the growing medical tourism business. Medical Tourism is being promoted as a viable solution to the financial dilemma regarding the costs of medical and surgical procedures that often result in a medical disaster for the patient. The guidelines being proposed in this paper seek to protect the health and life of patients by making sure they are fully informed of the medical and legal risks and benefits of any proposed treatments and procedures they may seek in a foreign country. The only hope is that with appropriate guidelines and standards, medical tourism can be rendered medically, legally and ethically more acceptable and be in the best interest of patients, physicians and society as a whole.

/pdf/medical-tourism-winners-and-losers-31hdmx6thm.pdf

Medical Tourism: Winners and Losers

A hunger strike is a form of speech that prisoners or detainees can use to communicate their concerns about some particular issue. Over the decades, whether in Ireland or Israel, the hunger strike has been viewed as a political weapon used by prisoners or the powerless. At the military detention center at Guantánamo Bay, Cuba, it is being used by detainees to protest their confinement and to protest the fact that guards improperly handled Korans during searches, charges that are denied by the United States military. According to sources, twice a day guards at Guantánamo take a number of detainees from their cells, one at a time to a camp clinic. The detainees are offered a hot meal or a liquid supplement and, if they refuse, they are strapped into a chair and are force-fed. A medical professional passes a nasogastric tube down their noses and down into their stomachs. They are fed a liquid supplement of Ensure for one to two hours.

https://print.ispub.com/api/0/ispub-article/14773

Force-Feeding at Guantánamo: Medical, Legal and Ethical Analysis

Technological innovations in medical care have led to the development of telemedicine programs in both rural and urban environments. The necessity for telemedicine has increased immensely as more cost-effective treatment options have become available for both patients and physicians through the addition of telecommunication technologies to medical practice. The development of telemedicine systems began as a means of providing access to health care resources for individuals living in isolated rural areas, grew into advanced medical intervention techniques for soldiers on the battlefield, and have become prevalent in urban medical centers both as a resource to the underserved populations and as a platform for physicians off-site to conduct patient consults remotely. Urban telemedicine systems, as monitored in the Mercy Health System (Philadelphia, Pennsylvania) and AtlantiCare Regional Medical Center (Atlantic City, New Jersey), display the enormous benefits of telemedicine as a form of preliminary analysis of patients for the treatment of various medical conditions including chronic disease, mental health disorders and stroke. However, the initiation of telemedicine programs requires new protocols and safeguards to be initiated to protect patient confidentiality/privacy, ensure the appropriate licensure of physicians practicing across state borders, and educate patients on the use of new technological systems. Telemedicine represents the progression of medicine in the presence of improving communication technologies and should be instituted in all urban medical centers. This conclusion is based upon the ethical responsibility to treat all persons with dignity and respect, which in this case, mandates the provision of the most cost-effective, beneficial medical care for all populations.

Telemedicine: medical, legal and ethical perspectives.

Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies. Despite supporting evidence, the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe marijuana to suffering patients. The use of medical marijuana has continued to gain support among states, and is currently legal in 16 states and the District of Columbia. This is in stark contrast to the federal government’s stance of zero-tolerance, which has led to a heated legal debate in the United States. After reviewing relevant scientific data and grounding the issue in ethical principles like beneficence and nonmaleficence, there is a strong argument for allowing physicians to prescribe marijuana. Patients have a right to all beneficial treatments and to deny them this right violates their basic human rights.

/pdf/medical-marijuana-medical-necessity-versus-political-agenda-4e64ko1r0h.pdf

Medical Marijuana: Medical Necessity versus Political Agenda

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Medical Tourism: Winners and Losers

Force-Feeding at Guantánamo: Medical, Legal and Ethical Analysis

Telemedicine: medical, legal and ethical perspectives.

Medical Marijuana: Medical Necessity versus Political Agenda