Ethics final

why do we conduct research?

research involving humans premised on a fundamental moral commitment to advancing human welfare, knowledge, and understanding to examining cultural dynamics

purpose of research ethics

Correct past problems

Prevent new problems and abuses

Law is not enough

what 2 major past atrocities lead to the advancement of healthcare ethics?

1. Nazi science

2. Tuskagee institute (Alabama)

Unethical research conducted that could not be conducted now

Dr. T. Clark, Tuskagee Study (1932-1972)

Studied the natural progression of disease because at the time there was no cure (syphilis)

- 399 untreated syphilitic African Americans

no informed consent

very risky inhumane treatment

Numberg code (1947)

Ethics code set in place to protect human subjects from enduring the kind of cruelty and exploitation the prisoners endured at concentration camps. Inspired by trials of nazi war criminals.

'the voluntary consent of the human subject is absolutely essential' (Article 1)

Declaration of Helsinki (1964)

the World Medical Association established recommendations guiding medical doctors in biomedical research involving human participants

Therapy vs research

what is the end goal

May find outcomes but will it be therapeutic?

Patient vs research subject

Patient is treated, research subject is used to find outcome

Right to Standard of Care (Declaration of Helsinki Amended in 1996)

Every patient including those of a control group, should be assured of the best proven diagnostic and therapeutic method

Do not expose them to tremendous risk

TPS (Tri-Council Policy Statement) - AKA "Tri-Council Code"

joint policy expresses the continuing commitment of the three Councils to the people of Canada, to promote the ethical conduct of research involving human subjects

Tri-Council Code 4 basic principles

Respect for persons - actively respect patients autonomy

Non-maleficence

Beneficence

Justice

Guiding Ethical Principles (1999)

Human dignity

Free and informed consent

Vulnerable persons

Privacy and confidentiality

Justice and inclusiveness

Balancing harms and benefits

Non-maleficence

Minimizing harm

Maximizing benefits

research subjects responsibilities

researcher is obligated To examine your consent for hidden reasons

If one becomes apparent, the researcher should refuse you

example of coercion/bias

Example 2 - HIV

Looking for HV cures

Go to places where transmission rates are high, and where ethical codes aren't strict

People got vaccines for work purposes - to keep their jobs ex; prostitutes

Coercion

expectation of favour - reference for parole, example of good behaviour, coincides with treatment)

Vulnerable populations

groups who have structural/systemic vulnerability to the powerful who may want to research using them

why are vulnerable populations more susceptible to influence/coercion?

Institutionalized disparity of power

An inability to respect their own interests

If the population have to consider punishment or rewards before participating

Susceptibility to power

inducement

reward received , but ultimately your choice

ex; something, a gift, reward etc

Seems irresistible

Inducement causes taking of unusual risk

Coercion vs. Inducement

Coercion \= Forcibly, against your will

Inducement \= reward, ultimately your choice

characteristics of valid informed consent

potential participants should understand the risks, potential benefits, procedures, and alternatives

3 facts participants must understand

research contribution - those who enroll in the study will be contributing to a project designed to gather generalizable knowledge to benefit others in the future

research relationship - the investigators will rely on participants' efforts to gather the generalizable knowledge to benefit others

research impact - the extent to which participating in the study will alter what participants do and what happens to them

Purposes of Informed Consent

the requirement for informed consent allows competent individuals to decide whether participation in research is consistent with their interests

allows individuals to decide for themselves whether they will enroll in the study in question

Lappé's Protein Theory

Central thesis in the book is presented as dietary advice but also has a strong moral tone to it

1. scarcity of food in the world

2. animals fed excessive protein in order to grow meat protein chickens eat 8 pounds of protein feed in order to produce 1 pound of meat protein

3. Humans don't need to eat animal protein to be healthy - we would be healthier if we ate the non-meat proteins we feed chickens

Conclusion --\> eating animals is short sighted and ultimately harmful to us and others

how much meat do we consume on average ?

Chicken 30.6 kgs

Beef 30 kg

Pork 28.1 kgs

Turkey 4.3kg

Veal 1.1kgs

Lamb 1.0 kgs

96.8 kgs of meat per person per year

is meat more popular now or in the past?

Meat is more popular now than ever - since 1972 chicken consumption has increased 84% and everything else has stayed the same

ecological impacts of animal farming

overpopulation of cattle and methane expulsions effect one the ozone

Fecal run off into water supplies

Grazing lands for cattle causing permanent damage to land surfaces (we can't grow anything else on that land, even after the beef farm disappears)

benefits of organic farming

- limit exposure to pesticides and anti-biotic resistant bacteria

- limited exposure to chemicals better for health

"Inhumane" Conditions in "Factory Farming?"

Production of animal products

Treatment of animals in factory farms

High density farms

Trying to save money and being efficient results in inhumane animal treatment

what does factory farming often lead to?

A lot of animals in one place - worries about animal diseases

The emergence of Zoonotic Infections - SARS, bird flu, etc

Pathogens exposed to humans from animals

Peter Singer theory

Believes that personhood could include higher order mammals but also exclude some disabled or damaged humans

Equality is about the equal consideration of interests, but humans ignore the interests of higher order mammals in order to suit their own comforts and pleasures

Singer is also strict utilitarian (great good for greatest number)

All he is doing is expanding the membership of the 'greatest number' - instead of just humans, it is mammalian persons

Speciesists

one who discriminates against another's rights by virtue of their belonging to another (non-human) species.

Singer's Concept of Personhood

a person is any creature (Human or non-human) who meets all of the following criteria:

1. Feel pain

2. Make own decisions

3. Foresee a future

4. Able to communicate

5. Ability to reason

6. Self-aware

7. Autonomous

claims about animals supporting singers theory

Sheep developed deep friendships

Cows are problem solvers

Animals have both reason and emotions in a relationship that is similar to our own