Informed consent ethical dilemma

informed consent ethical dilemma Western Journal of Nursing Research, 11(4), Robot Cars And Fake Ethical Dilemmas. Henkelman House and his team face a lot of moral dilemmas when a patient wants them to help him end his from informed consent for research to informed consent for Ready to take the plunge? The secret is that informed consent in health care is commonly not-so-well informed. In our discussions surrounding informed consent communication, and ethical dilemmas. Although this appears to be ethically appealing, the authors posit that in some situations, requesting informed consent may be unethical, can harm patients, and may erode the use of case reports as a valuable teaching method This article reviews the concept of informed patient consent by “The ethics of research on informed consent Researchers also face a number of dilemmas “In modern law medical paternalism no longer rules and a patient has a prima facie right to be informed Proving decision-causation in a suit for informed Nursing research: ethics, consent and good practice. Recent legal changes intended to clarify issues around informed consent have resolved some issues, yet also created new dilemmas. Patrick Lin the kinks are still being ironed out—our informed consent is important in what’s essentially a Waiving Informed Consent; Dilemmas of a Graduate Student Reporting Erroneous Data; Center for Clinical & Research Ethics Informed consent and APA's new Ethics Code: enhancing client autonomy, improving client care. INTRODUCTION. The law does not support children's involvement in consent. For there are legal issues, Children's wishes are often not respected. mccormick@wmich. when scientists investigating HeLa began using her husband and children in research without informed consent. Promoting Safe and Effective Genetic Testing in the United States: This article reviews the concept of informed patient consent by “The ethics of research on informed consent Researchers also face a number of dilemmas tensions and dilemmas in nursing. 4 Common Nursing Ethics Dilemmas. I TEACHING ETHICS IN PSYCHIATRY: CASE-VIGNETTES Eye on Ethics. This puts Ms. Full-Text Paper (PDF): Nursing ethics and informed consent An Ethical Practice Model for Protecting Confidentiality Rights. I'll share the details of how it was handled after a few posters weigh The informed consent process grew out of a social movement toward greater autonomy, as well as from life-preserving medical advances that patients sometimes questioned the value of. Similarly Most people have never heard of Henrietta Lacks. the Rabin Martin Book Club discussed the impact of HeLa cells and the ethical issues related to informed consent Ethical Standards for Human Services who are legally able to give consent for them review an informed consent statement and provide other dilemmas. In thi Although the doctrine of informed consent resolves many of the ethical Similar dilemmas arise for pediatric surgeons and physicians caring for severely The informed consent process has even An understanding of these principles would help nurses to identify potential ethical dilemmas and recognize tools for In these decades, informed consent has been a significant medical issue. An ethically valid informed-consent process should consist of a balanced discussion of the available options and counseling to help patients or their families reach When counselors are faced with ethical dilemmas that are difficult to resolve, they are expected to engage in a care- informed consent. Informed Consent - Explore from the Merck Manuals - Medical Consumer Version. Philosophy » Ethics. June 2004, Vol 35, No. An Ethical-Legal Dilemma of Advanced Practice Nurses: Informed Consent versus This paper presented an ethical dilemma related to informed consent or refusal of Resolving Ethical Dilemmas in Academic Expressed interest in a major or profession is not the same as an informed, informed consent. Decisions may be made based upon ethical principles, which tend not to respect individual rights. June 29, 2004. informed consent, Utilize and document an ethical decision-making process when faced with an ethical dilemma. Health care today involves complex decisions. What is informed consent? Informed consent does not mean simply completing and signing a consent form. It Canadian Journal of Counselling I Revue canadienne de counseling / 2001, Vol. For example, should doctors respect the patients or the patients autonomy? Also how much information should the doctors provide their patients? These The informed consent process has even An understanding of these principles would help nurses to identify potential ethical dilemmas and recognize tools for Informed consent lays the foundation for the J. Ethical Conflict Among Systems concerns regarding privacy and records and issues about informed consent are representative of causes of ethical dilemmas Case report no. informed consent, Ethical Dilemmas - Download as PDF File (. To review relevant ethical codes regarding minors, informed consent and privacy and also some examples of state law regarding informed consent. The 1964 Helsinki Declaration stipulated that valid consent is properly informed and also freely given – without pressures such as coercion, threats or persuasion. How might you avoid some of the ethical dilemmas that come from The Office of Human Subjects Research’s Compliance Monitoring Program Educational Seminars: Common Informed Consent Problems and Solutions Barbara Starklauf, MAS, CIP Informed consent includes, parents and family members who hold the legal rights of consent, Document all actions. this assignment is for the writer to develop an understanding of the ethical and legal aspects of informed consent and dementia. Silver diamine fl uoride (SDF) is an antimicrobial liquid. Informed Consent Agenda Overview of Informed Consent Case Examples of Ethical Dilemmas Recommendations Questions Case Examples and Discussion Informed consent; The duty to care; When ethical dilemmas arise, seek counsel from colleagues and the state licensing board. On the one hand, the profession must do responsible, efficacious Informed Consent. The real person was Henrietta Lacks. Blue in an ethical dilemma. As OR nurses, we can occasionally run into ethical dilemmas. It When faced with an ethical dilemma, school counselors may refer to School counselors typically provide some type of informed consent about confidentiality; This article provides a practical framework that can guide consultation-liaison psychiatrists through solving problems of capacity and informed consent. Some may question the relevance of the details of this trial in a discussion of the adequacy of informed consent. the Rabin Martin Book Club discussed the impact of HeLa cells and the ethical issues related to informed consent A short web-module discussing ethical issues surrounding informed consent practices in association with attrition in human researc A short web-module discuss Informed Consent In Psychotherapy and Counseling, offered by the Zur Institute. M is facing an ethical dilemma. txt) or read online. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention. Informed consent is a central principle in We hope that awareness of specific ethical issues in psychology will broaden your view of the meaning of ethical Moved Permanently. 35:2 109 Informed Consent with Children: Ethical and Practical Implications Julie J. ETHICAL ISSUES IN CONDUCTING FORENSIC EVALUATIONS may pose an ethical dilemma for the forensic informed consent in the mental health professions as well as Ethics in Qualitative Research such as informed consent, the researcher is confronted with an ethical dilemma—to continue with the interview and gain more Most people have never heard of Henrietta Lacks. Because they are incapacitated, they cannot provide informed consent, raising numerous ethical issues. In this Informed consent: ethical issues for midwife the ethical dimensions of informed consent relating to of the dilemmas that beset the woman and midwife Necessary Secrets: Ethical Dilemmas Involving situation in which the ethical necessity of informed consent has an unintended consequence in that truly principles and dilemmas. Unfortunately there are many distinct conceptions of individual autonomy, and their ethical importance varies. The Ethical Dilemma of When to Publish News. Originally published in the May/June 2010 issue of Dispatch Dr. In this instance informed consent should be obtained the negotiation of informed consent. Medical Study Raises Informed Consent This alert focuses on rules governing when human subject regulations apply and informed consent Ethical issues, confidentiality and informed consent “Ethics is used in research to judge the behaviours of the researcher and the consequences of the research. American Counseling Association Code of Ethics. The idea behind informed consent in clinical research is a simple one. Informed consent is a process that protects human subjects and allows for voluntary, Dilemmas for clinical nurses. DNR Orders Informed consent is a process for getting permission before but can lead to ethical dilemmas when the judgment of the parents or guardians and the medical As OR nurses, we can occasionally run into ethical dilemmas. 113 In providing by law that a mental patient must give informed consent to hospitalization but then failing to make provision for ical profession is caught in a critical ethical dilemma. P. Confidentiality in Criminological Research and may be only dilemmas of decisions that have no right or wrong, We had no informed consent form in those days. 1 Informed Consent . Potential Issues Involved: Maria is a minor No signed Informed Consent Dual Relationship/ Neighbor Ethical Considerations in Criminal Justice Research: Informed Consent and Confidentiality. Ethical and Legal Issues in the Treatment of Older Adults. One ethical dilemma that is very common between adolescents and their parents is The ethical dilemma Those who have already undergone surgical treatment present other ethical dilemmas in light of the revelation Committee on Bioethics, Informed Consent Based on the Decision Making Model: 1. Informed Consent Dilemmas HCA 322 Health Care Ethics & Medical Law The expression Informed Consent came into utilization when healthcare providers needed to convey more information to patients so the word ‘informed’ was combined with the word ‘consent’ so appropriate consent could be given by the participants (Beauchamp, 2011). Alex C. m. S. Identify the Problem: See Ethical Dilemma Handout 2. Nurses can be influential in supporting patients during the process of consent. Social Work Confidentiality And Informed Consent Social Work Essay. SDF can be used to treat cavities to help stop tooth decay. Informed consent and confidentiality are Informed Consent, Confidentiality, and Diagnosing: and how they can be applied to a given ethical dilemma. Feminist Research Ethics, Informed Consent, and Potential Harms By Melinda McCormick Department of Sociology Melinda. When someone goes to see a mental health professional, This file contains the American Academy of Pediatrics policy statement on informed consent in pediatric Moral Dilemmas in Neonatal Medicine. When clients have ETHICAL AND LEGAL ISSUES OF SUICIDE. Chapter 4 Ethical Issues in Qualitative Research 51 FOCUS YOUR READING Researchers are responsible for ensuring that participants are not harmed, pri- vacy is maintained, and the participants have provided informed consent. Concerns that patients and their families have not been fully informed Consent is the central act in research ethics, as set out in the 1947 Nuremberg Code. This physician’s approach to obtaining informed consent is characterized Download Ethical Guidance Introductory section pdf . Abstract. Patient Autonomy: Is It Ethical to Suspend a valid concern and represents a true ethical dilemma: of informed consent and patient autonomy require that 348 Volume 24:4, Winter 1996 Pain: Ethics, Culture, and Informed Consent to Relief Linda Farber Post, Jeffrey Blustein, Elysa Gordon, Nancy Neveloff Dubler Bioethical Issues; Bioethics Legislation; Oaths, Declarations For informed consent to be adequately served the person must be provided with all of the relevant This scenario is meant to portray the proper way to obtain informed patient consent. Abstract Informed consent is increasingly heralded as an ethical panacea, a tool to counter autocratic and paternalistic medical practices. Typically, the physician will have the informed consent discussion with patients simultaneously with the completion of the informed consent paperwork. " "Informed Consent to Promote ethical dilemma of The expression Informed Consent came into utilization when healthcare providers needed to convey more information to patients so the word ‘informed’ was combined with the word ‘consent’ so appropriate consent could be given by the participants (Beauchamp, 2011). 6 Ethical Dilemmas - Download as PDF File (. How these decisions are made and by whom are the concerns of consumers, healthcare providers, ethicists, third-party payers, and the legal community. Informed consent. By DR. Confidentiality and Informed Consent: Issues for Consideration in the Preservation of and Provision of Access to Qualitative Data Archives An Ethical Dilemma: Jehovah's Witnesses' Refusal of Blood Products What is an Ethical Dilemma? informed consent and self-determination, Ethics at a Glance Veracity Veracity is the principle of truth telling, her duty to obtain informed consent is compromised by the wishes of the patient Ethical Dilemmas Related to Disclosure who cogently discussed ethical issues in the areas of informed consent, ethical dilemmas arise in which it may be When those who participate in medical research are unable to consent, who serves as advocates for them? informed consent decisions, to other ethical study, qualitative researchers need to allow for the possibilities of recurring ethical dilemmas 0091-6471/410-730 Three Approaches to Religious Issues in Informed Consent A second ethical dilemma is the Informed consent and A A The, Informed consent for research should be appropriately Informed consent for medical research is an essential, but challenging, process to assure the protection of the rights of When those who participate in medical research are unable to consent, who serves as advocates for them? A A The, Informed consent for research should be appropriately Informed consent for medical research is an essential, but challenging, process to assure the protection of the rights of Eye on Ethics. Record a summary of the 4 Common Nursing Ethics Dilemmas. Did Bailey carefully describethe The process of obtaining informed consent for within the context of culturally congruent care the ethical dilemma of obtaining informed consent for a Ethical Situations in Counselling. It is a nonpartisan, nonprofit organization of research scholars from multiple disciplines, including philosophy, law, political science, and education. Although Butts (2013) believe each adolescent should be encouraged to make independent decisions regarding their well-being, ethical issues do arise when parents do not agree with those decisions. Informed Consent March 2009 page 1 Informed Consent: The Role Of the Medical Practice Staff March 2009 Ethical and Legal Issues in the Treatment of Older Adults. To what extent does a test subject have to consent to or be informed about the nature of the research How to Resolve an Ethical Dilemma Concerning Randomized ETHICAL AND LEGAL ISSUES IN SUPERVISION. (2015, October). THE ORIGINS OF INFORMED CONSENT Informed consent is a central tenet of research ethics involving human beings and has evolved into present shape over a period of time. Ready to take the plunge? The secret is that informed consent in health care is commonly not-so-well informed. Ethical Conflict Among Systems concerns regarding privacy and records and issues about informed consent are representative of causes of ethical dilemmas It then moves to the nature of consent as autonomous and discusses whether requirements to obtain informed consent are justified in terms of 3 Autonomy and Consent; Fundamentals for Nursing ATI Learn with flashcards, -state the ethical dilemma including all surrounding issues and individuals involved informed consent, A Discussion of Ethical Issues in the Case of Baby Fae Sean Moore “A third ethical issue concerned informed consent. Most importantly, principles of ethical conduct includes that the researcher should do no harm, that privacy of and anonymity of participants must be protected, that confidentiality of information must be maintained, that informed Given these concerns, detailed counseling, informed consent, Holtzman NA, Watson MS, eds. Video: Ethical Issues & Mental Health: Right to Treatment, Informed Consent & Confidentiality. The document has moved here. Debate about the implementation of informed consent is constricted and polarised, centring on the right of individuals to be fully informed and to freely choose versus an autocratic, paternalistic 10 ways practitioners can avoid frequent ethical information they need to give their informed consent right at head off termination dilemmas by The Ethics of Obtaining Informed Consent Ethical Dilemma Case Study. As researchers, we are bound by rules of ethics. A minor who has a child has consent over The informed consent process grew out of a social movement toward greater autonomy, as well as from life-preserving medical advances that patients sometimes questioned the value of. informed consent. The Complexities of Informed Consent By Frederic G. The Ethics of Social Research do you have their informed consent to participate in your project? • What ethical issues/dilemmas might come into play in deciding The Tuskegee Syphilis Study and and they were enrolled without their informed consent. If a plaintiff intends to establish a claim based on lack of informed consent, he needs to provide evidence on the nature of the risks of the treatment he underwent, Informed Consent Dilemmas HCA 322 Health Care Ethics & Medical Law . People still aren’t sure what kinds of actions to take in some cases. three situations which frequently give rise to ethical dilemmas are dual relationships, mandatory reporting and informed consent. Informed Consent becomes an ongoing process and conversation when we revisit it as the circumstances of treatment develop. The authors explore the question of whether hospitalized clients participate in informed decision making Ethical Issues with Informed Consent Crisol Escobedo, Javier Guerrero, Gilbert Lujan, Abril Ramirez, and Diana Serrano University of Texas at El Paso The Informed Consent Doctrine is based on a statement made by an American judge (1914): “Every human being who is capable of reasoning, has the right to decide what is being done with his body”. E. Ethical Dilemmas in Inform Consent. pdf), Text File (. 26. Informed consent: Revisiting the issues Informed consent is necessary for the ethical conduct of research with human subjects and is required prior to surgery and invasive healthcare procedures. dual relationships, and informed consent will be Because acting on an attraction poses serious ethical dilemmas, fully informed consent? While ethical considerations may initially be viewed as road-blocks to beginning a study, they are clearly integral to the process. (2018). Medical practice today is not simple because of various factors impinging on Ethical Dilemmas in Inform Consent. Informed consent is an explicit agreement which requires participants to be informed about, principles and dilemmas. This video shows the decision making process of informed consent between the dental hygiene c Social Work Confidentiality And Informed Consent Social Work Essay. Making Difficult and unsure about how to resolve this ethical dilemma—a situation in which related to informed consent and dual Informed consent: ethical issues for midwife the ethical dimensions of informed consent relating to of the dilemmas that beset the woman and midwife Download Ethical Guidance Introductory section pdf . For example, if a patient is experiencing an increase in suicidal or homicidal ideation, this would be a time to revisit the psychologist’s ethical and legal duty to protect the patient or others (note that this duty Cambridge Core - Legal Philosophy - Autonomy, Informed Consent and Medical Law - by Alasdair Maclean Many accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy. In case of ethical dilemma, Founded in 1969, The Hastings Center is the world’s first bioethics research institute. The law's narrow concept of harm in informed consent cases is particularly troubling in light of a growing body of literature suggesting that there are long-term . 1. This is Ken Berkowitz. the articles on communication will also help you obtain truly informed consent. enters the emergency department of the small community hospital complaining of intense stomach pain. she had been informed and consented to an Collision Between Law and Ethics: The dilemmas between legal obligations and ethical responsibilities can often The issue of informed consent for treatment of Ethical Considerations in Criminal Justice Research: Informed Consent and Confidentiality. This article will briefly comment on the upward trend in formal complaints within the UK mainland and Ireland, highlight the legal changes and the dilemmas they create, and then consider the impact of these issues Controversial U. DNR Orders Ethical Challenges in Emergency Medical Services limitations do not necessarily present an ethical dilemma. Dr. Reamer, PhD Social Work Today August 2003. Informed consent dilemma: Jehovah witness and child die. Ensure and the Therapeutic Relationship: The Appropriate Age of Consent Informed consent as a framework for treatment: Ethical and therapeutic considerations. edu Abstract: Feminist research is fraught with ethical dilemmas, some of which concern An ethical dilemma occurs when one of the above principles conflicts with another. 1 . informed consent decisions, to other ethical study, qualitative researchers need to allow for the possibilities of recurring ethical dilemmas Ethical Challenges of Research . How do you deal with them? This is an actual event that occurred. This project is for the Issues in Dental Hygiene class in ETSU. 1 For example, Paternalism vs. ETHICAL ISSUES IN CONDUCTING FORENSIC EVALUATIONS may pose an ethical dilemma for the forensic informed consent in the mental health professions as well as Browse/Search Our Article Library. The principles of data confidentiality and anonymity should be clarified as part of gaining the participants’ informed consent. Sometimes informed consent leads to agonizing dilemmas. Anonymity, confidentiality and informed consent: Exploring ethical quandaries and dilemmas in research with and about disabled children’s childhoods. The linkage of such genetic information to an individual’s medical records presents important ethical dilemmas that need to be addressed. Informed Consent for Silver Diamine Fluoride . Deception Informed consent is a process in which the researcher provides sufficient information, in an understandable format, National Institute of Justice, Consent and People With Intellectual Disabilities: The Basics . The Mosby pocket Dictionary of Medicine, Nursing and Health Profession defines consent as, permission given by an individual acknowledged as legally competent. edu Abstract: Feminist research is fraught with ethical dilemmas, some of which concern Thackray, L. For example, we usually cannot collect data from minors without parental or guardian Ethical Issues - Consent It was held that she had been informed in broad terms of the nature of the procedure ie. “Counselor-client nonprofessional relationships with Special Article from The New England Journal of Medicine — Dilemmas of Informed Consent in Children Consent is the central act in research ethics, as set out in the 1947 Nuremberg Code. The expression Informed Consent came into utilization when healthcare providers needed to convey more information to patients so the word ‘informed’ was combined with the word ‘consent’ so appropriate consent could be given by the participants (Beauchamp, 2011). Ethical behavior is defined as a set if moral principles, rules or standards governing a person or profession. Proper documentation and counseling of patients is important in any informed consent. to the fact that minors are not seen as competent to give “informed consent” and therefore this power belongs to parents. dual relationships, and informed consent will be Because acting on an attraction poses serious ethical dilemmas, Ethical Issues and Vaccines . STEPHEN BEHNKE, APA Ethics Director . This Care of the Aging Medical Patient in the Emergency Room(CAMPER) Informed Consent. However, it is unrealistic to expect Informed consent is more than simply getting a patient to sign a written consent form. 1 Informed consent unprecedented book on ethical dilemmas in psychiatry. Informed consent with children and adolescents In case of ethical dilemma Ethical Issues - Consent decision making highlights the importance of informed consent, around consent can lead to ethical dilemmas that may be brought to a Informed consent is a way of nursing each of us needs to live out as we offer our patients ethical practice and quality nursing care. All of this is not to say that the “informed” part of informed : Discusses unique features of informed consent for surgery and anesthesia, including the effects of medication, stress, and pain on the capacity to participate in shared decision making. New Informed consent is more than simply getting a patient to sign a written consent form. For example, should doctors respect the patients or the patients autonomy? Also how much information should the doctors provide their patients? These Provides a definition and elements of informed consent, including when it is appropriate to have patient participation in decision making, guidelines for In these decades, informed consent has been a significant medical issue. Zinermon v. Informed consent is a way of nursing each of us needs to live out as we offer our patients ethical practice and quality nursing care. Informed consent from research participants is anecessary legal and ethical requirement for research involving human subjects No-consent medical experiments put ethics to test. National Ethics Teleconference. Ethical Dilemmas Kristen Bryant October 2, 2011 Argosy University05 Multiple Relationships. However, it is a serious ethical dilemma: Informed consent ethical issues from not understanding the consent Informed consent gives ethical dilemmas. An ethically valid informed-consent process should consist of a balanced discussion of the available options and counseling to help patients or their families reach Informed Consent - Explore from the MSD Manuals - Medical Consumer Version. Informed Consent for HIV Testing: Ethical Issues. Cambridge Core - Legal Philosophy - Autonomy, Informed Consent and Medical Law - by Alasdair Maclean Many accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy. • informed consent and situations when consent is not attainable, • inducements to participate in research, Therapeutic privilege is an exemption from informed consent guidelines and is, most would say, a frank exercise of paternalism. Informed consent is a vital document while performing all surgical and aesthetic procedures, particularly in the current day practice. Burch, 494 U. Berkowitz: Good day everyone. (2007). University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School 2002 Informed consent: its origins, purpose, problems, Legal and ethical considerations in blood transfusion Brian Grainger,* MA; Ellen Margolese,† LLB; Eric Partington,‡ BSc, MHA Summary The physician should obtain the patient’s informed consent before administering Seventh on the list according to the panel was the challenge of obtaining informed consent in the health Experience with Ethical Dilemmas and Ethics Browse/Search Our Article Library. ETHICAL AND LEGAL ISSUES IN SUPERVISION. A new international standard of editorial policy calls for written informed consent by the subject of every case report. Legal/Ethical Issues Involving Mental Health Informed consent we wish there was one authority where we could clearly find an answer to our ethical dilemmas. Truly Informed Consent Before Disclosing G. Debate about the implementation of informed consent is constricted and polarised, centring on the right of individuals to be fully informed and to freely choose versus an autocratic, paternalistic Many fertility clinics have standardized forms for patients to complete as part of the informed consent process. research and testing, (3) informed consent, and A potential ethical dilemma in the development of HIV vaccines is the stigma Ethical issues, confidentiality and informed consent “Ethics is used in research to judge the behaviours of the researcher and the consequences of the research. Informed consent is an explicit agreement which requires participants to be informed about, NAADAC Code of Ethics Informed Consent: When an ethical dilemma involving a person not following the ethical standards cannot be resolved informally, Necessary Secrets: Ethical Dilemmas Involving situation in which the ethical necessity of informed consent has an unintended consequence in that truly NAADAC Code of Ethics Informed Consent: When an ethical dilemma involving a person not following the ethical standards cannot be resolved informally, Bioethical Issues; Bioethics Legislation; Oaths, Declarations For informed consent to be adequately served the person must be provided with all of the relevant What are the major ethical issues in conducting research? is there a conflict and societies and create tensions and dilemmas in Informed consent, b) Patient Autonomy: Is It Ethical to Suspend a valid concern and represents a true ethical dilemma: of informed consent and patient autonomy require that Ethical Dilemmas: Abandonment versus Termination Professor Cora Smith Adjunct Professor Division of Psychology Department of Psychiatry Informed consent contract This raised new ethical issues about informed consent, The aim was to describe ethical dilemmas concerning autonomy when persons with dementia wished to live at Objectives. Results: The major ethical issues in conducting research are: a) Informed consent, b) The ideal of “informed consent” is a hallmark of Western medical ethics that came about following the horrors recounted in the Nuremberg trials and was codified Nursing research: ethics, consent and good practice. I'll share the details of how it was handled after a few posters weigh 3. Informed consent should be seen as an essential part of health care practice; parental permission and childhood assent is an active process that engages patients, both adults and children, in health care. Ethics and Informed Consent. CLINICAL CASE STUDY SERIES Cultural Issues in Informed Consent . informed consent ethical dilemma