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Contact investigation is an evidence-based intervention of multidrug-resistant tuberculosis (MDR-TB) to protect the public health by interrupting the chain of transmission. In pursuit of contact investigation, patients’ MDR-TB status has to be disclosed to third parties (to the minimum necessary) for tracing the contacts. Nevertheless, disclosure to third parties often unintentionally leads the MDR-TB patients suffered from social discrimination and stigma. For this reason, patients are less inclined to reveal their MDR-TB status and becomes a significant issue in contact investigation. This issue certainly turns into a negative impact on the public interest. Tension between keeping MDR-TB status confidential and safeguarding the public health arises in relation to this issue. Regarding MDR-TB management, patient compliance with treatment and contact investigation are equally important. Patients might fail to comply with anti-TB therapy and be reluctant to seek healthcare due to disclosure concern. In order to have treatment adherence, MDR-TB patients should not live through social discrimination and stigma arising from disclosure and TB team has a duty to support them as a mean of reciprocity. However, implementation of contact investigation as a public health policy can still be challenging even with promising reciprocal support to the patients because MDR-TB patients are living in different contexts and situations. There can be no straight forward settlement but an appropriate justification for each distinct context is needed to strike a balance between individual confidentiality and public interest.

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Approximately a quarter billion people around the world suffer from malaria each year. Most cases are located in Sub-Saharan Africa where Anopheles gambiae mosquitoes are the principal vectors of the disease. With the use of CRISPR-based gene drives, the population of mosquitoes can be modified, eventually causing their extinction. In this paper, the various ethical concerns that accompany these genetically modified mosquitoes (GMMs) will be discussed. First, the value of mosquito species is evaluated. Acceptance of the eradication of a species depends on the moral status of the organism. Since mosquitoes are generally attributed a low moral status, using GMMs to combat malaria should not be abandoned based on some moral value of A. gambiae. Possible environmental impacts due to the eradication of A. gambiae or the use of gene drives will also be explored. Environmental impact studies have to be performed to obtain an accurate account of these possible effects. The risks from the purposeful extinction of A. gambiae should not overtake the benefits of eradicating malaria and risk assessments should be used to determine acceptable risks. The eventual release of the GMMs will depend on transparency, community involvement and cooperation between different nations. This study aims to provide a first thorough view on the ethical complications of genetically engineered mosquitoes for the sake of public health. Ethical insights into the practical implementation of this technology will contribute to an informed discussion.

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The recent development of a groundbreaking culture system that allows human embryos to develop in vitro for longer than ever before has revived the debate on how long embryos should be allowed to develop outside of the mother’s womb. By mimicking implantation in a dish, human embryos attached and developed until 14 days, the legal limit recommended in 1984 by the Warnock committee and that has been translated into law in many countries, including Belgium. Born at the time of the first successful attempts of in vitro fertilization and in the context of an emerging debate on the status of the human embryo in vitro, the 14-day limit was chosen as a solution of compromise on three main grounds: first, no functional nervous system has developed, precluding fears of the embryo experiencing pain or having conscience; second, it corresponds to the end of implantation; and third, it precedes primitive streak formation which indicates an individual is not present. Amongst international calls to extend this period to 21 or even 28 days, here we analyze whether these three arguments are still pivotal to uphold the limit at 14 days. We argue that although all three arguments are still valid, a nervous system is not functional for longer than 14 days and would not hinder extending the limit even to 28 days; implantation is allowed to occur in the present regulatory system and thus does not constitute an argument to uphold or extend the rule; finally, a less stringent interpretation of the biological criteria for individuality could allow to extend the limit to 21 days. Overall, we stress that grounding normative conclusions on biological facts is a matter of choice and must be carried out with extreme caution in a perduring context of irreconcilable disagreements on the status of the human embryo.

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Background: Carrier screening is the genetic testing of asymptomatic individuals or couples to identify those who are at increased risk of conceiving a child affected by a monogenic autosomal of X-linked recessive disorder. Technological advances have made it possible to screen for hundreds of recessive disorders in a single test. This panel-based screening is called expanded carrier screening (ECS). Since October 2019, a Belgian Genetic Expanded Carrier Screening test (BeGECS) is available to all couples planning a pregnancy in the form of a pilot study. To ensure a responsible implementation of ECS in Belgium, it is necessary to gain insight into the societal views regarding ECS. Objective: The aim of this study was to explore the interest, attitudes and preferences of the broad general population in Belgium regarding ECS. Materials and methods: Between October 11 and December 9, 2019, a written, paper survey was administered to patients in the waiting room of six different general practices in the provinces of Antwerp and Flemish Brabant, Belgium. Prior to completing the survey, written background information was provided about the concept of carrier screening, the risk of being a carrier couple and the associated risk of conceiving an affected child, and the reproductive options available for carrier couples. Results: The survey was completed by 707 participants with a mean age of 45.6 years old. Most participants (59.3%) had not heard of carrier screening prior to participating in this study. Moreover, 52.3% of our respondents perceived their risk of being a carrier as (very) low. In total, 57.7% of the participants indicated intention to participate in ECS. The great majority thought it (rather) acceptable to test both couples with a desire to have children (85.5%), individuals (81.2%) and pregnant women (80.6%) for their carrier status. However, a considerable part of our respondents were concerned that ECS will lead to a great pressure to get tested (56.7%), to a greater anxiety (45.6%) and to unrealistic expectations of having a healthy child (37.4%) among couples planning a pregnancy. The gynecologist (72.5%), the general practitioner (70.0%) and the center for human genetics (65.4%) were by far the preferred providers of ECS. Couple-based test results were preferred by more respondents (46.7%) than individual test results (31.3%). Most participants (64.9%) were willing to pay out-of-pocket for ECS. Of those, 53.0% were willing to pay a maximum of 150 euros and only 3.9% were willing to pay more than 600 euros. Conclusion: This study indicates a considerable interest and an overall positive attitude among individuals of the general Belgian population regarding ECS. However, the study findings also emphasize the necessity of informing and educating the general population about ECS, and providing qualitative pre- and post-test counseling to prospective parents to address potential misconceptions and concerns. The results of this study can be used in the ongoing debate about the acceptability and desirability of ECS and support the responsible implementation of ECS in the Belgian healthcare system.

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Background: End of life decisions has always been a topic of controversy between health care professionals from ethical aspects to the personal attitudes of the care providers towards making the decision of withdrawal of life support systems, particularly tube feeding. Objective: The aim of this systematic review was to identify questionnaires that investigated the views and attitudes of health care providers on withdrawal of enteral tube feeding in terminally ill patients. Methods: A search of three online databases (PubMed, Web of Science, CINAHL) using keywords relating to the withdrawal of nutrition in terminally ill patients. Abstracts for articles that met the inclusion criteria were fully reviewed. Results: It was found that physicians’ acceptance of withdrawal of enteral tube feeding is higher than the acceptance of nurses. This difference was regarded to the difference of the nature of roles between the two. Where physicians strictly diagnose and treat, nurses ensure that the patients’ needs are met of which feeding is a major part of. Conclusion: Where physicians had their views, nurses had opposing ones. More quantitative studies should be done to conduct future policies that helps ease decision making regarding this matter.