Berna Arda

A randomised controlled trial of ribavirin in Crimean Congo haemorrhagic fever: ethical considerations

The randomised controlled trial (RCT) constitutes a quantitative, comparative, controlled study of a particular treatment, and provides invaluable evidence regarding its pharmacotherapeutic efficacy. These studies are generally predicated upon the ethical principle of clinical equipoise. However, this may be insufficient to justify withholding treatment from a control group while assessing drug therapy in a potentially fatal disease. Thus, the criteria for randomisation, informed consent methodology and timing, and consideration of treatment options in such a scenario remain the province of medical ethics. This paper addresses the need for an RCT of ribavirin in the treatment of Crimean Congo haemorrhagic fever, and highlights underlying ethical concerns in light of the current medical, virological and ethical literature.

What does Al-Qanun Fi Al-Tibb (The Canon of Medicine) say on head injuries?

A historical approach could help in the detection of some viewpoints that cannot be paid attention to or signified by a purely medical one. In this text, the important points of Ibn Sina’s (Avicenna) treatise on head injuries have been introduced in light of neurosurgery. The most detailed chapter regarding head injuries in Canon, under the title of “Fracture of the Skull,” presents rather detailed knowledge concerning skull fractures and their surgical treatments in the eleventh century and the medical paradigm of that era. Ibn Sina provided extremely systematic knowledge on head traumas along with both his observations and experiences and citations from the writings of the ancient physicians, Galen and Paul of Aegina. Regarding the treatment of skull fractures, Ibn Sina is a real successor of Galen and Paul of Aegina.

Publication Ethics from the Perspective of PhD Students of Health Sciences: A Limited Experience

Publication ethics, an important subtopic of science ethics, deals with determination of the misconducts of science in performing research or in the dissemination of ideas, data and products. Science, the main features of which are secure, reliable and ethically obtained data, plays a major role in shaping the society. As long as science maintains its quality by being based on reliable and ethically obtained data, it will be possible to maintain its role in shaping the society. This article is devoted to the presentation of opinions of PhD candidate students in health sciences in Ankara concerning publication ethics. The data obtained from 143 PhD students from the fields of medicine, dentistry, pharmacy and veterinary reveal limited but unique experiences. It also shows that plagiarism is one of the worst issues in the publication ethics from the perspective of these young academics.

How we derived a core curriculum: from institutional to national—Ankara University experience

As the first phase of a major curricular change in a large medical school the core curriculum had to be determined. The criteria for the inclusion of topics in the core curriculum were defined for both clinical and basic sciences. A large group of faculty members have worked in 11 sub-groups to determine the core knowledge, skills and attitudes for undergraduate medical students. During this work 608 clinical topics have been reviewed. Four-hundred and eighty five of them (79%) have been included in the core curriculum. Clinical and basic science knowledge, skills and attitudes relevant to these topics have been defined and classified. A total of 1610 cognitive, 428 psychomotor skills and 247 attitudes have been named. Thus the core curriculum defined is not just a set of diseases, conditions and symptoms but also includes the details of each and every topic. Starting from this point the medical school has participated actively in defining the national core curriculum, which has also been determined according to the same criteria.

Arda B How should physicians approach a hunger strike

In the last year many prisoners and their supporters in Turkey have gone on hunger strike. This paper from a Turkish physician and ethicist discusses problems faced by physicians. It is followed by a background note on the situation in Turkey and, more generally, on medical responses to hunger strikers.

Ethical and legal aspects of stem cell practices in Turkey: where are we?

Advances in medical technology and information have facilitated clinical practices that favourably affect the success rates of treatment for diseases. Regenerative medicine has been the focus of the recent medical agenda, to the extent of fundamentally changing treatment paradigms. Stem cell practices, their efficacy, and associated ethical concerns have been debated intensively in many countries. Stem cell research is carried out along with the treatment of patients. Thus, various groups affected by the practices inevitably participate in the discussions. In addition to discussions based on avoiding any harm, providing benefits and respecting personal autonomy and justice, problems arise owing to the lack of legal regulations for stem cell research and practice. The dimensions of the problems vary in the developing countries, with widespread use of advanced medical technology but with lack of sources allocated for healthcare, dominance of paternalistic physician–patient relationships and failure to achieve a sufficient level of awareness of patients’ rights. This article discusses the current situation of stem cell practices within the context of regenerative medicine in Turkey and ethical concerns about some of the legal regulations, such as the Regulation for Umblical Cord Blood Banking and Guidelines for Non-embryonic Stem Cell Study for Non-clinical Purposes directing the research on this issue.

The importance of secularism in medical ethics: the Turkish example

In light of all the historical events surrounding Turkey (a nationalist movement led by Mustafa Kemal, won a war of independence (1919–23) on behalf of values like individual freedom, secularism and democracy, and abolished the sultanate and the caliphate), without forgetting the fact of globalization, the secular and democratic model should be developed all over the world. It means that the consideration of the present well-being of mankind should predominate over religious considerations in civil affairs and public education. There are significant differences between developed and developing countries in terms of human rights and developing countries have some features such as paternalism and authority, a poor concept of democracy, illiteracy and dominating religious beliefs and dogmas. Secularism in the Moslem world has a vital importance like other societies and the Western world seems to have realized this fact after 11 September 2001. Turkey is an almost unique model as it has been a secular country in the Moslem world since 1923. The reflections of this approach to the daily life of medicine, medical ethics and legislation in Turkey will be the main focus of this text.

Account of Haly Abbas regarding the management of hydrocephalus in children: a text from medieval times.

OBJECTIVE To present the text on hydrocephalus from Haly Abbass book Kitāb al-Malikī / Liber Regius (The Royal Book), which was accepted as a classical textbook in the Eastern and Western worlds for a long time. METHODS The Arabic (Süleymaniye Manuscript Library, Murad Molla Collection, Nr: 1482 and Būlāḳ, 1294 /1877) and the Latin (Venice, 1492) versions of the related chapter was translated and compared to create an English text. Additionally, relevant literature was reviewed in detail. RESULTS The text on hydrocephalus in Haly Abbass The Royal Book virtually resembles Paul of Aeginas work. For hydrocephalic cases where the fluid collects between skin and pericranium, and pericranium and bone, Haly Abbas had made little change in surgical intervention; for the third type, skin incision, he preferred a T-type incision instead of an H-type. Like Paul of Aegina, Haly Abbas also did not advise any surgical intervention for the cases of hydrocephalus, where fluid accumulation is between bone and the dura mater. CONCLUSIONS Haly Abbass approach to hydrocephalus was as brave as that of his predecessors Antyllus, Oribasius, and Paulus, although the cases they dealt with were almost all cephalic hematomas. Although his chapter on the treatment of water accumulation in the head contains surgical interventions in extracranial hydrocephalic conditions, his account on hydrocephalus is extremely precise and gives adequate detail as in other chapters in his book.

Enhancing John Rawls's Theory of Justice to Cover Health and Social Determinants of Health

The vast improvements in medical technology reviled the crucial role of social determinants of health for the etiology, prevalence and prognosis of diseases. This changed the content of the right to health concept from a demand of health services, to a claim of having access to all social determinants of health. Thus, the just allocation of scarce resources of health and social determinants of health became an issue of ethical theories. John Rawls developed a theory of justice. His theory suggests that the principles of justice should be determined by individuals in a hypothetic initial position. In the initial position, individuals agree on principles of justice. Rawls puts forth that the institutions of the society should be structured in compliance with these principles to reach a fair social system. Although Rawls did not justify right to health in his theory, the efforts to enlarge the theory to cover right to health flourished quite fast. In this paper first the basic components of Rawls theory is explained. Then the most outstanding approaches to enlarge his theory to cover right to health is introduced and discussed within the discourse of Rawls theory of justice.

An Evaluation Regarding the Current Situation of Stem Cell Studies in Turkey

Turkey is in a parallel state to that of other countries for developments in stem cell research and practices. Nevertheless, Turkish law has no regulations for stem cell practices. To define a legal framework for stem cell research, rules of general content should be used as the starting point. In 2005 and 2006, a general regulation and guidelines on stem cell research were published by Turkish Ministry of Health. Thus, the ministry, based on this first general regulation, stopped “Embryonic Stem Cell Research”, while allowing “Adult Stem Cell Research” by a second general regulation. The method of such research was regulated with the addendum of ‘Guidelines for Clinical Research on Non-embryonic stem Cell’. With the latest regulation, clinical stem cell research in Turkey has been based on ‘Regulations for Clinical Research’, which was legislated in 2009. However, the aforementioned regulations by the ministry are still legally binding. In addition, other regulations such as Medical Deontology Regulations of 1960 and Patients’ Rights Regulations of 1998 are to be consulted for stem cell research in Turkey. While it is especially important that research that is still at experimental level not provide an opportunity for trade of hope in patients and their relatives, ethics discussions are enlightening in developing regulations and critical evaluation of current practices.