I'm going to try this new post as a way to respond holistically to the prior week's posts. Since I'm reading them after you've all posted, I'm missing the opportunity to be in the conversation and give feedback. That's a problem with the asynchronous nature of online and especially blogging. I'll date my responses so you know where I am and then we can try next week to have a meta-conversation about what we're learning and how our ideas about these topics in biomedical ethics are evolving.
So, some follow-up points. 29 May 15
1. Re: vulnerable patients and research. I agree that vulnerable populations should only be involved in research if care is made to safeguard them. But could you elaborate on informed consent? If you're concerned with impoverished people in developing countries, are you similarly concerned with the impoverished, uneducated here? Do you see such people at work? Do you take extra steps to make sure that they are sufficiently educated for real informed consent?
2. Re: Codes of Ethics
Cindy and/or Shirley: could you elaborate on how you see the Codes being manipulated?
Donna, Cindy, Sherry: Interesting that you bring up the Nazis. Our codes were in place after WWII, but American doctors and researchers continued to violate them. I suppose this is what some of you mean when you say that the Codes can be manipulated. So is it still important to have the Codes? What do they do?
I still think that we should have all our codes. These are guidelines that we all use for caring for our patients. I did not realize until after our research class last 8 weeks that american researchers violated the these codes. We did hit on some of the subjects like the non treatment of syphilis patients, also the injection of cancer cells into patients without them knowing. I believe that some instances of misconduct in research happens because the researcher takes a act-utilitarian point of view. The act itself may be wrong or illegal but it is worth it because it is serving a better cause and helping more people.
ReplyDeleteI think we are equally concerned with the impoverished in developing countries as well as in our own. The comparison was to illustrate that we agree it is not right here, so should not be right anywhere else as well. I think subconsciously it seems easier to do research elsewhere because there is a detachment from your own community and no real personal involvement with regards to the research outcomes.
ReplyDeleteWith regards to taking extra steps to make sure our impoverished patients are sufficiently educated on the topic of informed consent, I know I most definitely do. I usually only have 2 patients that I care for on a daily basis and sometimes this allows me to spend extra time for education. Usually it's not just a single person but the entire family who needs help. The only downfall I see with the education process is time. Everyone learns at different paces and sometimes it takes more time to educate the uneducated and impoverished. Sometimes having enough time as a nurse to do all the education that is needed may be challenging. I'm always up for a good challenge but having to rely on someone else to follow up for me to verify or clarify that the educated material is understood can be daunting also. So you do the best you can for the time that you have.
ReplyDeleteI think that if I worked for a research program I would spend as much time as needed to make sure complete understanding is given and regurgitated back. This would make the research subject feel more safe and comfortable knowing they are making a well educated decision, be it aye or nay.
American's manipulated these codes until at least the 70's and even with laws in place, what would stop a slightly unethical person from breaking the rules to control the outcome? It is a constant struggle for people in the fight against good and evil, right and wrong. The codes are to guide us and attempt to prevent an ethical dilemma. It does not always work perfectly because we are human and some have less morality than others. It is a fine line.
ReplyDeleteCindy's comments remind me of the Enron scandal. Some of what those folks did wasn't technically illegal, it was just pretty bad for others. A more ethical work place might have discouraged that practice.
ReplyDeleteI think many times we are uncomfortable telling the patients the full risks of the procedures. I had a patient recently who wanted to cancel a test (stress) because of how the consent states there is a risk of death. A few of us let her ask questions and assured her that we had all emergency equipment available should anything go wrong. In the end she had the test and called our manager the next day to tell her she appreciated the information. Most people do not read the full consent, but when they do, they almost always ask if we have ever had anyone die during the test.
ReplyDeleteAll vulnerable populations should be well informed and given equal opportunity and access to treatments and information.
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