Monday, March 8, 2010

And the Beginning of a New Term; Three Ethics Scenarios

I think that at times there is some confusion in separating out research ethics from clinical ethics. In the case of the latter, we are referring specifically to the ethics of patient care when patients seek care from a physician for a problem that they have. In such cases, it is assumed that the physician will do everything in his or her power to help the patient get better. A physician might try a particular drug, or perhaps a particular adjusting technique, and if that does not work, he or she might try something completely different. In research ethics, as contrast, the main goal is to obtain generalizable information, and in such cases researchers are constrained by the protocols of their study. Which means that they might not be able to try all possible avenues or interventions for their patient. All too often, neither patient nor researcher really understands this. And this is but one small point of difference. Just to illustrate some of the challenges in bioethics, I offer here a few scenaries, without providing any answer or resolution to them, just to give you an idea of the complexities I mentioned above.

Scenario 1: You have developed a new method of treating patients suffering from Alzheimer’s disease. You wish to compare your intervention to an established method of treating this debilitating and distressing condition, and the best way to do so is to conduct a two-arm clinical trial, randomizing treatment into one of two treatment groups (your method or the established method). However, you are well aware that you must receive informed consent from the patient, yet many of the patients are not lucid or have, at best, periods of lucidity. How should you proceed with obtaining consent?

Scenario 2: Professor Allan Sundry is the course director of a physiology laboratory taught to chiropractic students. One of the laboratory exercises involves students’ drawing blood from one another (under supervision) and using the serum to perform a variety of chemical and cellular analyses. The lab exercise is carried out successfully. At its conclusion Professor Sundry announces to the class of 50 students that he would like to retain their leftover blood sera. He informs them some of the sera will be used individually while some will be pooled. In all cases these sera will be used to gather baseline control data in a number of research projects. He asks if anyone wants to refuse having his or her serum used for research but receives no objections. Are Allan’s actions appropriate? Is an IRB-approved protocol needed? Do the students need to give informed consent?

Scenario 3: You have submitted a new paper to a reputable journal in which you present some exciting data based on a technology you are in the forefront of developing. A number of weeks go by and you do not hear anything from the journal, so you contact the editor to find out why. He tells you that the paper is still in review and the one reviewer has yet to return a completed review. Shortly after, you see a new paper in a different journal, and it contains information that can only have come from your paper. What ethical transgressions may have occurred and what should you do?

Think about how you might respond to each of these scenarios…

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