Ethics in the rheumatology literature: A systematic review

Abstract

Objective. To address the perception that ethical issues are underrepresented in the rheumatology literature, a systematic review was conducted using multiple databases to identify articles that addressed ethical and rheumatologic issues. Methods. A rheumatologist, research librarian, and clinician-ethicist designed queries for 4 electronic and ethics databases, searching for articles with content that was relevant to rheumatology/rheumatic diseases and that primarily focused on ethics. Based upon the Beauchamp and Childress framework, the retrieved articles were classified according to their ethical content, and the proportions addressing each Beauchamp and Childress ethical principle were analyzed using Cochran's Q statistic. Correlations between the appearance of discussions involving each of the 4 ethical principles were determined via chi-square analysis. Results. The total number of manuscripts in the rheumatologic literature with an ethical focus was 104 out of an estimated library of >400,000 rheumatologically oriented manuscripts (0.026%). Very few manuscripts consisted of original research studies. Nonmaleficence (66%) was the most common theme, whereas justice represented the least frequently addressed ethical issue (12%). The differences in the proportions of each ethical principle reached statistical significance (Q ‫؍‬ 73.8, P < 0.0001). Only 8 articles addressed >2 ethical principles. Discussion touching on autonomy and nonmaleficence frequently appeared in the same article (Pearson's 2 ‫؍‬ 14.9, P < 0.001). Conclusion. Despite the frequency of ethical issues while caring for patients, few reports within the rheumatic disease literature have focused on ethical issues. Further work should ascertain the degree to which the literature addresses the ethical questions in rheumatology.

Everyday ethics and help-seeking in early rheumatoid arthritis

“…Ethics underpins medicine, yet medical ethics has limited application in the 'everyday world' of healthcare; only 20% of practitioners describe the available ethics literature as helpful in practice [1]. Traditionally, medical ethics has centred on acute illness, not chronic conditions [2] and prioritized four principles: respect for autonomy, non-maleficence, beneficence and justice [3].…”

A Systematic Review of Ethical Principles in the Plastic Surgery Literature

“…These findings are consistent with Frederick A. Paola's prior review on this subject, reporting that an “ethics gap” exists between medical and the surgical subspecialty, with medical literature having a much greater percentage of literature devoted to bioethics (3, 4). The reason for this scarcity of bioethical publications is unclear, but may reflect different priorities within plastic surgery, a lack of understanding of formal ethical concepts, a detached research interest in bioethics, discomfort with non-quantitative disciplines, or a variety of other reasons (5). Nonetheless, it is concerning that plastic surgery literature is substantially lacking in ethical discourse.…”

“…Studies have shown that there is a disproportionately small amount of ethical content in the medical literature (3, 4). For example, a recent analysis of ethical content in the rheumatologic literature found that in an estimated library of >400,000 rheumatology- related articles, only 104 had an ethical focus (5). …”

The ethical challenges in rheumatology

“…Despite their frequency, ethical issues have not engendered much discussion in the rheumatic disease literature. A systematic review of this topic revealed a remarkably low rate (0.026 %) of published articles addressing the well-known bioethical model (autonomy, beneficence, nonmaleficence, or justice) [1]. MacKenzie et al [2••] have recently rejuvenated this dialogue with an article on the perceived ethical issues among American rheumatologists.…”