Ethics And Research Flashcards
What is the purpose of research
Research: the process used to expand human knowledge and understanding
In a medical context, research is done in order to develop new models of disease, new treatments and ultimately improve patient care.
The end goal is to decrease human suffering from disease and illness.
Therefore, research is an ethical undertaking (done for ethical reasons)
What is the ethical issue with research
Research requires a shift of focus - need to look at large groups of individuals, to establish patterns.
Therefore, in research people are reduced to data-points in a large dataset - there is a dehumanising element to research.
Ethical issue: individuals’ interests are not held as centrally as would be in normal Dr-patient relationship.
What has been produced to combat bias in research
Humans are vulnerable to bias in how they interpret findings and results
Therefore we have developed processes of blinding and double-blinding, after which results are pooled, and trends statistically analysed
What is the medical contract is research
research is vital to know what would serve those interests but the process of gaining that information may require those interests to be suspended:
When an individual participates in research, there is no clear or certain benefit to them:
They do not know which treatment arm they will be on (old vs new, new vs placebo)
They might benefit
They might not - it is even possible they will come to harm
How is participating in research an altruistic act
It will benefit society as a whole e.g. sufferers of this disease, but it may not benefit this individual.
What should consent be in research
- Voluntary
Potential for subtle forms of coercion? E.g. Offering enrolment in trial to someone in hopeless situation - Informed
Patients should be informed as fully as possible
However the uncertainty of the research must be emphasized (researchers do not know all the potential risk and benefits). - Capacity
patient should have capacity to make decisions
Capacity will be at a higher threshold than with an established treatment which has a clear association with improvement.
Why is trust the central of medical interactions
In the context of a lack of knowledge (research) trust is even more important
It is also important that there is trust in the outcomes of research 🡪 people should be able to trust the data generated.
What are some examples of research in history
Frist clinical trial in Europe:
The first clinical trial in Europe took place in 1721, on prisoners from Newgate prison, condemned to death, who were given a pardon in exchange for their inoculation with smallpox
Nazis:
The experiments conducted by Nazi doctors in concentration camps 🡪 performed without anaesthesia or consent
This constituted as medical torture
It included deliberate infection with TB, malaria, hepatitis, simulation of battlefield wounds to allow testing of antibiotics, as well as chemical burning with mustard gas
Victims included Jewish inmates, Romani, Sinti, Poles, Soviet POWs
What are examples of unethical medical research
Exploitation of Poor:
Paying volunteers exploits the poor 🡪 makes them take risks that they would not have otherwise taken if not poor.
Career advancement of junior doctors hinged on publication. This system pushes towards unethical behaviour.
Reputable journals were more than happy to publish the results without questioning too thoroughly the means they were obtained.
Why does data not necessarily reflect our population
E.g.
Ethnic minorities are less likely to receive all vaccinations
They have a lower expressed trust in medical professionals
They are less likely to donate organs
What is the Tuskegee scandal
What are vulnerable groups in research
On members of the population that cannot consent:
- Children
- Those with learning difficulties
Therefore, children regularly suffer because we have a lack of data on their treatment.
What are the conflicting interests in research
A large amount of research today is undertaken by pharmaceutical companies
They may publish what is in their interests, and opt not to submit negative results for publication.
What are flaws in the system of research
low-quality research, duplicate studies - participants suffering the burden of research with no clear societal benefit
What is the summary
Research is ethically necessary, and it is necessary for all evidence-based practice
However, it does not follow that a sacrifice must be made to obtain it:
Research can be done safely and ethically - if that is kept as the central concern
However, in the past, it has not been performed ethically.
Poor ethical practice still dogs the industry today
If research is seen to be ethical, participation will increase, and all will benefit
