Medical dilemmas and issues of research and ethics
2); 2014 s:article | pubreader | epub (beta) | printer friendly | are the major ethical issues in conducting research? Mail: mantzorou@ for more related articles at health science ound: research ethics involve requirements on daily work, the protection of dignity of subjects and the publication of the information in the research. However, when nurses participate in research they have to cope with three value systems; society; nursing and science which may be in conflict with the values of subjects, communities, and societies and create tensions and dilemmas in nursing. Method and material: using the medline and the nursing cinahl data base, the most important ethical issues which appear in bibliography, will be addressed. After a short description of the nature of nursing, and the advocacy role of nurses, the writer will attempt to highlight the possible conflicts that nurses have to deal with, when undertaking or participating in research. Results: the major ethical issues in conducting research are: a) informed consent, b) beneficence- do not harm c) respect for anonymity and confidentiality d) respect for privacy. However, both the nature of nursing which focuses on caring, preventing harm and protecting dignity and the advocates role of nurses which calls for defending the rights of subjects, are sometimes incongruent with the ethics in research. Conclusions: ethical issues, conflicting values, and ambiguity in decision making, are recurrently emerging from literature review on nursing research. Because of lack of clarity in ethical standards, nurses must develop an awareness of these issues and an effective framework to deal with problems involving human ch ethics, moral dilemmas in research, nature of nursing, nursing research, nursing is rooted in the ancient greek philosophical inquiry of moral life. 1] it is said that ethics is the branch of philosophy which deals with the dynamics of decision making concerning what is right and wrong. Scientific research work, as all human activities, is governed by individual, community and social values.
Enumerate and explain the ethical implications of technology
Research ethics involve requirements on daily work, the protection of dignity of subjects and the publication of the information in the r, when nurses participate in research they have to cope with three value systems; society; nursing and science. The societal values about human rights, the nursing culture based on the ethic of caring and the researcher's values about scientific inquiry. According to clarke these values may conflict with the values of subjects, communities, and societies and create tensions and dilemmas in nursing. However, the ethical attitudes of researchers drawn the interest of society only after 1940's because of human exploitation in several cases. 4] the nazi experiments led to the nuremberg code (1947) which was the leading code for all subsequent codes made to protect human rights in research. This code focuses on voluntary informed consent, liberty of withdrawal from research, protection from physical and mental harm, or suffering and death. 5] the only weak point of this code was the self regulation of researchers which can be abused in some research studies. It was only in 1964 with the declaration of helsinki that the need for non therapeutic research was initiated. 6] the declaration emphasised the protection of subjects in this kind of research and strongly proclaimed that the well being of individuals is more important than scientific and social interests. Since then there has been a significant development of professional codes in conduct and research. The american nurses' association (ana) guidelines for research, the human rights guidelines for nurses in clinical and other research (1985) and the royal college of nursing code for nurses in research (1977) provide a strong assistance to professional nurses as well as reassurance to patients, the public and society, of professionals’ intentions.
Characteristics and ethics of research
3] of course individuals can make informed decisions in order to participate in research voluntarily only if they have information on the possible risks and benefits of the research. 12] free and informed consent needs to incorporate an introduction to the study and its purpose as well as an explanation about the selection of the research subjects and the procedures that will be followed. 13] the researcher must inform the subjects about the methods which will be used to protect anonymity and confidentiality and indicate a person with whom they can discuss the study. The researcher must also take into account that persons with physical, cultural and emotional barriers may require a very simple language in order to understand him. 5] this is very important but raises the issue of how difficult the subjects can withdraw after developing a personal and sometimes friendly relationship with the researcher. 12] with regard to withdrawal a researcher may be in a dilemma in case many subjects choose to withdraw at an advanced stage of the study, because this can affect the validity of the results. The principle of beneficence includes the professional mandate to do effective and significant research so as to better serve and promote the welfare of our constituents". Carr says that if the research findings prove that it was not beneficial as it s expected, this can raise immense ethical considerations especially for nurses. 16] ford and reutter say that "beneficence relates to the benefits of the research, while non-malificence relates to the potential risks of participation". A researcher tries to learn intimate details of the participants lives he has to deal with opening old wounds. A researcher must consider all possible consequences of the research and balance the risks with proportionate benefit.
List of research ethics
If the researcher is not able to promise anonymity he has to address confidentiality, which is the management of private information by the researcher in order to protect the subject's identity. Clarke addresses the ethical dilemma of the researcher when confidentiality must be broken because of the moral duty to protect society. If a researcher, though, acts deontologically he may feel that he has not protected society. Another issue is that the researcher may have to report confidential information to courts which can also dilemmas. 3] even if there are no duty conflicts, the researcher faces several problems with respect to maintaining confidentiality especially in qualitative research where conduct is personal, the sample is smaller and the reports display quotations of interviews. Department of health and human services (dhhs) may be useful to help ensure the privacy of research participants especially in studies in which participants and researchers may be exposed to compelled legal disclosure of research researchers must always bear in mind all psychological and social implications that a breach of confidentiality may have on subjects. All aims, instruments and methodology must be discussed with the prospective subject and the research workers prior to the and treece suggest that whenever subjects refuse to report personal information as they regard it an invasion of privacy, the researcher ought to respect their views. They also imply that privacy can be invaded when researchers study certain groups without their knowledge and without identifying themselves. An example of such a study that the researcher hid his identity, was humphrie's study "impersonal sex in public places" in which, he observed homosexuals during sexual activities in public men's rooms. 5] in conclusion, all possible measures have to be taken in order to protect subjects from potential physical, psychological or social damage during the research or after circulation of the results. Groups of ys, there is an increased concern about vulnerable groups and whether it is ethical or not for them to be used as research subjects.
List and explain five ethics of research
23] so, vulnerable groups include captive populations (prisoners, institutionalised, students etc), mentally ill persons, aged people, children, critically ill or dying, poor, with learning disabilities, sedated or different opinions about their participation in research can be attributed to their inability to give an informed consent and also to their need for further protection and sensitivity from the researcher as they are in a greater risk of being deceived, threatened or forced to participate. Many are in favour of the use of such subjects in research whilst others would argue strongly against it. Most condition their responses according to the seriousness of the research, the level of potential risk and the availability of alternatives. An intense analysis of potential risks and benefits should be the first step of starting such a research and careful approach should exist both in acquiring consent and during the research procedure itself. In the case of mentally ill patients, it is important to measure comprehension and develop valid tools for it, before obtaining informed consent to participate in a research study. 25] however, the potential improvement of their nursing care raises the issue of careful consideration before rejecting or accepting this kind of of the n declares that in research the three more important elements are the competency of the researcher, the careful design, and worthwhile expected outcomes. 13] the royal college of nurses declares that nurse researchers should have the necessary skills and knowledge for the specific investigation to be carried out and be aware of the limits of personal competence in research. Inexperienced researchers should work under qualified supervision which has to be reviewed by an ethics committee. Is more, careful choice of method for data collection, to ensure validity and reliability, are two main requirements that must be met in all kinds of research. When human beings are involved, all the ethical issues, discussed above, must be taken into account. 8] however, both the nature of nursing which focuses on caring, preventing harm and protecting dignity and the advocates role of nurses which calls for defending the rights of subjects, are sometimes incongruent with the ethics in cence-non malificence.
Common feature in professional conduct codes and those specific to research is the principle of non-malificence. 8] this statement raises the issue of advocacy when nurses have to protect patients from the researchers’ incompetence or unethical behaviour. Even if nurses are certain about the incompetence of the investigator, which is usually very difficult, they have to deal with serious dilemmas. 13] if the researcher does not inform or compensate patient then nurses have to decide between the duty to safeguard the well-being of patient and be loyal to them, and the loyalty to r, even if nurses decide that their duty of caring and being loyal to the patient is more important, they may have to deal with the hierarchical and bureaucratic systems of institutions which demand loyalty to subordinates to the institution. In case the incompetent researcher is a higher status professional, nurses may be obliged to show loyalty, but this can conflict with loyalty to patients. This is merely why many authors believe that it may not be possible for nurses to act as advocates of subjects in research. Possible issue of conflict is that the caring nature of nursing with regard to the right of patients to the best treatment/care is sometimes conflicting with the aim of research in non therapeutic studies. According to the belmond commission the general aim of practice is to enhance the well being of individuals while the purpose of research is to contribute to general knowledge. This distinction highlights the differences in the aims of a nurse practitioner and a researcher. 41] this compensation must be planned in advance so that enough money and time will be order to prevent human exploitation, ethics committees were introduced. 43] clark warns that there is a danger that the members may have vested interests in a research.
3] the success of any ethics committee will always depend on the commitment and moral competency of its members. If instead of the patient and his needs, the central aims of the committee are personal interests, profits and academic prestige, then nurses will have none to share their concerns with, and deal with their dilemmas in research. 26] moreover, the committees should be less strict so as not to prevent knowledge development in issue of confidentiality which is stated as very important in the hippocratic oath, is another possible issue of conflict for nurses either as practitioners or researchers. 9] on the other hand the icn code for nurses in research states that: "nurses acting as data collectors must recognise that they are now committed to two separate roles " . To the professional code they can not reveal confidential information not even to the members of the research team. It is important therefore, to seek advice in ethics committees to get approval for disseminating the results of the data collection including an account of what happened. 26] in addition, they have to deal with the issue of anonymity when some features of the research make the subjects easy to identify. When dilemmas according to confidentiality arise, trust as a basic element of a therapeutic relationship should be considered and maintained. Involved in research, have to consider many ethical problems relating to the issue of informed consent. The icn code for nurses in research, states that nurses as practitioners may be called upon to witness that informed and voluntary consent has been obtained from the subjects of research. Webb suggests that the informed consent is an obligation of the researcher and no nurse should obtain it on behalf of another professional, nor agree to give the explanation as a substitute.
Conflicting issue is that giving information to patients is accepted as a major role of the nurse; but if for the sake of a research, nurses have to withhold information, this may create conflicts when they have to decide whether to participate or not. 40] hurst suggests that if nurses cannot tell patients about the true research objectives, they should provide a full explanation at the end of data collection. 45] provided, of course, that a supervisor body has decided that disclosure should not be full in order not to invalidate the research t, can however, be a major ethical issue for nurses when it involves persons with diminished autonomy, such as children, aged, mentally ill etc. Nurses taking part in research on children should be alert, in order to notice any verbal or non verbal dissent which warrants exclusion of the child from the study (even if this creates conflicts with the researcher. 46] in the same prospect, nurses must act as advocates when vulnerable groups are used in research, and not prevent it. According to levine, restricting these groups from research could end in disadvantaging those populations, even further, especially when research involves no risk and a high potential for benefit. Role regard to nurse researchers, the international council of nurses declares that they are not responsible for the care of patients. 3] the commitment of nurses to caring, may create dilemmas according to the conflict between the researcher's and clinician's a researcher nurse provides physical or psychological care during an interview, the results will be biased and generalisation will be difficult. 5] another issue raised from the icn statement, is to determine when a "harmful situation appears imminent" and the intervention of the researcher is required. 3] this can solve some of the ethical dilemmas of the nurse, but in case the situation is not lifethreatening, the conflict remains. Burns and grove suggest that in case that support from the researcher is required, then, it should be given, but the subjects should be excluded from the research.
Nevertheless, most health professionals, no matter how skilled they are in supportive techniques will provide some care if they feel that it is needed in a certain l issues, conflicting values, and ambiguity in decision making, are recurrently emerging from literature review on nursing research. Because of lack of clarity in ethical standards, nurses must develop an awareness of these issues and an effective framework to deal with problems involving human rights. This is necessary in order to come into terms with the issue of the researcher's values relative to the individual's rights versus the interests of society. Professional codes, laws, regulations, and ethics committees can provide some guidance but the final determinant of how research is performed, rests with the researcher's value system and moral code. Hunt suggests that in order to liberate nursing from its "technocratic impasse" ethics should be broadly interpreted as an arena of new ideas which can change professional hierarchies, to open cross-disciplinary discussions, and question the concepts "abnormality", "patient" and " illness". He also declares that nursing, not as a biomedical branch, but as a science and art of caring, is able to start the redefinition of research in health care which was in the recent history dominated by the biomedical "paradigm". Nursing research,1982;(1): 43- college of nursing, ethics related to research in nursing, london,d p. Pmcid: pmc2094750medical ethics: debates, dilemmas and decisionsjoanne embree, md frcpcjoanne embree, university of manitoba, winnipeg, manitoba;author information ► copyright and license information ►copyright © 2000, pulsus group inc. All rights reservedduring the past five to 10 years, medical ethics has become a high profile and popular medical subspecialty. This has resulted in considerable interest and debate concerning medical ethics in the lay press as well as in medical journals. At every medical school in canada, numerous rounds each year are devoted to this subject.
Allegations of unethical behaviour on the part of physicians, medical school professors, hospital boards, university administration officials and the pharmaceutical industry regularly result in front page headlines and prime time television news features. On occasion, these allegations are related to some aspect of infectious on a search of the world wide web in early march of this year, there appear to be 3991 web sites concerned with medical ethics in relation to a variety of infectious diseases. Of these, nearly one-third (1696) concerned the ethical issues surrounding routine vaccine administration to children or the military. In contrast, although there were 32,499 citations on medline related to medical ethics, there were only 645 articles concerning infectious disease. These mostly involved statements and opinions related to hiv/aids research and treatment opportunities in developing countries. There were 118 medical citations related to the ethical issues surrounding vaccines, primarily concerning the anticipated hiv vaccine trials. The topics found on the various lay web sites included these issues but mainly explored opinions concerning a vast array of other subjects. It would seem that the debate on these topics in the lay press far exceeds that among the medical profession. Are a large number of ethical considerations that we deal with on a day-to-day basis as we see patients, conduct our research, and fulfill our administrative obligations to the hospitals, clinics, universities and/or government agencies to which we are affiliated. Examples of these considerations include such issues as deciding whether to recommend an invasive procedure, such as a lung biopsy, to determine the infecting agent when the patient has a terminal disease; deciding what information to include in a study consent form; or deciding whether to vaccinate routinely a group of individuals at higher risk than the general public for a particular infection. We also have many potential conflicts of interest when dealing with some government agencies that play major roles in our ing upon the circumstances, any of these situations could result in the identification of major ethical dilemmas and heated public debates.
In general, we tend to discuss ethical issues with those individuals directly involved with an expectation that, at the end of the conversation, a correct decision will be made and implemented. Great deal of good does ultimately come from identifying ethical problems, debating the issues and viewpoints of those involved, and arriving at a decision about how to deal with them. For those of us who have practiced or conducted research in the aids field, our involvement in the ethical debates surrounding the rights of those affected with hiv has come to be accepted and appreciated. This explains, in part, the preponderance of articles in the medical literature related to ethical issues associated with aids. If we do not take on a role in medical ethics, wrong decisions may be made or, worse yet, no decisions may be made at all. We also need to arrive at a consensus concerning those ethical issues that are important to us. Finally, we need to take the time to develop teaching modules for medical students and residents to teach them to examine the ethical problems related to infectious diseases that they might be confronted with in the future. In this way, we may avoid some of the mistakes that were made in the es from the canadian journal of infectious diseases are provided here courtesy of s:article | pubreader | epub (beta) | pdf (53k) | l stem cell hymal stem cells & cells and neurone ogical emcell nic stem cell research: an ethical nic stem cells offer hope for new therapies, but their use in research has been hotly debated. Blastulas used in research are typically made artificially in a laboratory or fertility is the rationale for different opinions? Supporters of esc research generally feel that using cells from these surplus blastula for research and developing medical treatments, which could help improve and save people's lives, is much better than throwing them does the middle ground lie? Debates and discussions about the moral and ethical views of escs help establish the rules and regulations that govern scientific research and the development of medical treatments using stem is important to realise that, although people may have very strong opinions on what is "best" for society, groups on both sides of this discussion are interested in helping and protecting human lives.
It forces us to choose between two moral principles:The duty to prevent or alleviate duty to respect the value of human the case of embryonic stem cell research, it is impossible to respect both moral obtain embryonic stem cells, the early embryo has to be destroyed. But embryonic stem cell research could lead to the discovery of new medical treatments that would alleviate the suffering of many people. If the natural process involves such loss, then using some embryos in stem cell research should not worry us protect a person’s life and interests not because they are valuable from the point of view of the universe, but because they are important to the person concerned. For example, the roman catholic, orthodox and conservative protestant churches believe the embryo has the status of a human from conception and no embryo research should be permitted. Judaism and islam emphasize the importance of helping others and argue that the embryo does not have full human status before 40 days, so both these religions permit some research on embryos. Factsheet on ethical issues relating to the sources of embyronic stem emcell factsheet on the science of embryonic stem t for 16+ year olds about stem cells and ethics from the factsheet was created by kristina hug and reviewed by göran hermeré courtesy of wellcome images: egg and sperm by spike walker; blastocyst on pin by yorgos nikas. Stem cell hymal stem cells & cells and neurone ogical emcell nic stem cell research: an ethical nic stem cells offer hope for new therapies, but their use in research has been hotly debated.
