In addressing the creation and regulation of biobanks in different countries, a short descriptive... more In addressing the creation and regulation of biobanks in different countries, a short descriptive introduction to the social and cultural backgrounds of each country is mandatory. The State of Israel is relatively young (established in 1948), and can be characterized as a multi-religious (Jewish, Muslim, Christian, Druz, and others), multi-ethnic (more than 14), multi-cultural (Western “Ashkenazi” Jewry, Oriental “Sfaradi” Jewry, Soviet Jewry, Israeli Arabs, Palestinian Arabs) society, somewhat similar to the American melting pot. The current population is 8.3 million, a sharp rise resulting from a 1.2 million influx of immigrants from the former Soviet Union in the 1990s. Seventyfive percent are Jewish, 20% Arabs (the majority of whom are Muslims), and several other minorities. The birth rate is 3.8 per family, the highest in the Organization for Economic Cooperation and Development (OECD).
The present study focuses on the way child protection officers (CPOs) in Israel assess suspected ... more The present study focuses on the way child protection officers (CPOs) in Israel assess suspected abuse and neglect (SCAN) reports made by hospital child protection teams (CPTs), to determine whether the alleged maltreatment is substantiated. The study was conducted in six medical centers and included 358 reports investigated by CPOs for SCAN. A structured questionnaire was completed by hospital CPTs to capture all relevant information on each child referred to the CPTs. Structured phone interviews were conducted with each of the CPOs who received a CPT report. Bivariate associations and multivariate logistic regressions were conducted to estimate the substantiation rate of cases reported by CPTs and the types of maltreatment substantiated, as well as to identify case characteristics of the child and the family that were associated with the CPOs' substantiation decision. CPO follow-up investigations revealed a substantiation rate of 53.5%. The maltreatment type most commonly substantiated was neglect. The case characteristics associated with substantiation included socio-demographic background, parents' health and functioning, previous contact with social services, characteristics of the hospital referral, medical findings and an assessment of the parents' behaviors. The findings of the study highlighted the importance of cooperation between the health and welfare services and the policy makers. This cooperation is essential for identifying early signs of maltreatment. Enhanced cooperation and effective information transfer between various professionals would help prevent or at least reduce the recurrence of maltreatment and would ensure that the children and their families are treated appropriately.
Periodic examination of UNOS’s policies is a useful feature of an ongoing effort to assure just a... more Periodic examination of UNOS’s policies is a useful feature of an ongoing effort to assure just and equitable allocation of lifesaving organs and to avoid potential exploitation by individuals. Yet, those whom the authors seek to protect - the majority of patients on the waiting lists and fortunate recipients - are in a morally awkward position because they have not indicated their willingness to donate organs prior to their ailments. Our comment explores this issue.
Force feeding of fasting hunger-striking prisoners is the subject of considerable controversy in ... more Force feeding of fasting hunger-striking prisoners is the subject of considerable controversy in Israel and elsewhere, posing a direct conflict between two basic ethical values: that of human life and respect for autonomy. The Israel Medical Association, as well as the World Medical Association, has taken the position that force feeding of such prisoners is an act of torture and is therefore unethical. However this paper presents an opposing view, which recently became the law in Israel, that, whereas the rights of prisoners to decree a hunger strike as a form of protest should be respected, if the prolongation of the strike reaches a stage of clear and present danger to the life and health of a prisoner, the saving of the prisoner's life must take precedence over considerations of autonomy. The paper present the steps that should be taken, including extensive and empathic efforts to persuade the prisoner to end his/her fast; gaining the approval of a hospital's ethics committee; and gaining the approval of a district court judge; the feeding is to be carried out in the most humane and sensitive manner as befitting a lifesaving procedure for any patient. This position is consistent with Israel's Basic Law: Human Dignity and Liberty, Israel's Patient Rights Law, Israel's "Do not stand idly by your fellow man's blood" Law, with several Israeli court decisions and in keeping with the dominant Israeli culture. Finally, instructions for physicians who object to such measures are discussed, ascertaining the freedom of conscience as well as preserving the life of the hunger-strikers.
Patients' rights laws, bills and charters aim at delineating the patient-physician relationsh... more Patients' rights laws, bills and charters aim at delineating the patient-physician relationship in regard to consent to medical treatment, confidentiality and related issues. The need to shape such an intimate relationship by way of legislation seems anomalous to some, but imperative to others. We present for the first time an insight into Israeli physicians' attitudes towards Israel's patients' rights laws, in a changing medical and socio-legal environment. The research results suggest that physicians are reluctant to participate in the implementation of such laws, demonstrated by the level of their misunderstanding of the law's norms and regulations, and subjective attitudes and perceptions. In order to ensure the medical community's participation in augmenting patients' rights, efforts should focus on improved legal and ethical education, enhanced cooperation of professional associations and joint action with legislators to assure a productive composit...
Organ transplantation has become a proven, cost-effective lifesaving treatment, but its promise i... more Organ transplantation has become a proven, cost-effective lifesaving treatment, but its promise is contingent on the number of available organs. The growing gap between the demand and supply results in unnecessary loss or diminished quality of life as well as high costs for surviving patients and their insurers. Twenty years after the enactment of the National Organ Transplantation Act, it is time to rethink the moral basis and overall design of organ transplantation policy. We propose a system of national organ insurance based on a social contract of reciprocal obligation under which aggregated present consent to donate guarantees future availability of organs for those who need them, at least to the level that prevents death while awaiting an organ. The national insurance plan will cover all peri- and post transplantation costs to all. By presuming consent to enroll, we align the default with widespread expectations of reciprocity and mutual self- interest, and surmount barriers t...
In addressing the creation and regulation of biobanks in different countries, a short descriptive... more In addressing the creation and regulation of biobanks in different countries, a short descriptive introduction to the social and cultural backgrounds of each country is mandatory. The State of Israel is relatively young (established in 1948), and can be characterized as a multi-religious (Jewish, Muslim, Christian, Druz, and others), multi-ethnic (more than 14), multi-cultural (Western “Ashkenazi” Jewry, Oriental “Sfaradi” Jewry, Soviet Jewry, Israeli Arabs, Palestinian Arabs) society, somewhat similar to the American melting pot. The current population is 8.3 million, a sharp rise resulting from a 1.2 million influx of immigrants from the former Soviet Union in the 1990s. Seventyfive percent are Jewish, 20% Arabs (the majority of whom are Muslims), and several other minorities. The birth rate is 3.8 per family, the highest in the Organization for Economic Cooperation and Development (OECD).
The present study focuses on the way child protection officers (CPOs) in Israel assess suspected ... more The present study focuses on the way child protection officers (CPOs) in Israel assess suspected abuse and neglect (SCAN) reports made by hospital child protection teams (CPTs), to determine whether the alleged maltreatment is substantiated. The study was conducted in six medical centers and included 358 reports investigated by CPOs for SCAN. A structured questionnaire was completed by hospital CPTs to capture all relevant information on each child referred to the CPTs. Structured phone interviews were conducted with each of the CPOs who received a CPT report. Bivariate associations and multivariate logistic regressions were conducted to estimate the substantiation rate of cases reported by CPTs and the types of maltreatment substantiated, as well as to identify case characteristics of the child and the family that were associated with the CPOs' substantiation decision. CPO follow-up investigations revealed a substantiation rate of 53.5%. The maltreatment type most commonly substantiated was neglect. The case characteristics associated with substantiation included socio-demographic background, parents' health and functioning, previous contact with social services, characteristics of the hospital referral, medical findings and an assessment of the parents' behaviors. The findings of the study highlighted the importance of cooperation between the health and welfare services and the policy makers. This cooperation is essential for identifying early signs of maltreatment. Enhanced cooperation and effective information transfer between various professionals would help prevent or at least reduce the recurrence of maltreatment and would ensure that the children and their families are treated appropriately.
Periodic examination of UNOS’s policies is a useful feature of an ongoing effort to assure just a... more Periodic examination of UNOS’s policies is a useful feature of an ongoing effort to assure just and equitable allocation of lifesaving organs and to avoid potential exploitation by individuals. Yet, those whom the authors seek to protect - the majority of patients on the waiting lists and fortunate recipients - are in a morally awkward position because they have not indicated their willingness to donate organs prior to their ailments. Our comment explores this issue.
Force feeding of fasting hunger-striking prisoners is the subject of considerable controversy in ... more Force feeding of fasting hunger-striking prisoners is the subject of considerable controversy in Israel and elsewhere, posing a direct conflict between two basic ethical values: that of human life and respect for autonomy. The Israel Medical Association, as well as the World Medical Association, has taken the position that force feeding of such prisoners is an act of torture and is therefore unethical. However this paper presents an opposing view, which recently became the law in Israel, that, whereas the rights of prisoners to decree a hunger strike as a form of protest should be respected, if the prolongation of the strike reaches a stage of clear and present danger to the life and health of a prisoner, the saving of the prisoner's life must take precedence over considerations of autonomy. The paper present the steps that should be taken, including extensive and empathic efforts to persuade the prisoner to end his/her fast; gaining the approval of a hospital's ethics committee; and gaining the approval of a district court judge; the feeding is to be carried out in the most humane and sensitive manner as befitting a lifesaving procedure for any patient. This position is consistent with Israel's Basic Law: Human Dignity and Liberty, Israel's Patient Rights Law, Israel's "Do not stand idly by your fellow man's blood" Law, with several Israeli court decisions and in keeping with the dominant Israeli culture. Finally, instructions for physicians who object to such measures are discussed, ascertaining the freedom of conscience as well as preserving the life of the hunger-strikers.
Patients' rights laws, bills and charters aim at delineating the patient-physician relationsh... more Patients' rights laws, bills and charters aim at delineating the patient-physician relationship in regard to consent to medical treatment, confidentiality and related issues. The need to shape such an intimate relationship by way of legislation seems anomalous to some, but imperative to others. We present for the first time an insight into Israeli physicians' attitudes towards Israel's patients' rights laws, in a changing medical and socio-legal environment. The research results suggest that physicians are reluctant to participate in the implementation of such laws, demonstrated by the level of their misunderstanding of the law's norms and regulations, and subjective attitudes and perceptions. In order to ensure the medical community's participation in augmenting patients' rights, efforts should focus on improved legal and ethical education, enhanced cooperation of professional associations and joint action with legislators to assure a productive composit...
Organ transplantation has become a proven, cost-effective lifesaving treatment, but its promise i... more Organ transplantation has become a proven, cost-effective lifesaving treatment, but its promise is contingent on the number of available organs. The growing gap between the demand and supply results in unnecessary loss or diminished quality of life as well as high costs for surviving patients and their insurers. Twenty years after the enactment of the National Organ Transplantation Act, it is time to rethink the moral basis and overall design of organ transplantation policy. We propose a system of national organ insurance based on a social contract of reciprocal obligation under which aggregated present consent to donate guarantees future availability of organs for those who need them, at least to the level that prevents death while awaiting an organ. The national insurance plan will cover all peri- and post transplantation costs to all. By presuming consent to enroll, we align the default with widespread expectations of reciprocity and mutual self- interest, and surmount barriers t...
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