Responsible Conduct in Research Fred Lombardo, Pharm.D.,MS Howard University.
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Responsible Conduct in ResearchResponsible Conduct in Research
Fred Lombardo, Pharm.D.,MS
Howard University
Basic BioethicsBasic Bioethics
Two predominate philosophies governing ethics in the Western world:– Deontological view-I. Kant (1724-1804)– Utilitarianism-John Locke (1632-1704) and
John Stuart Mill (1806-1873)
Deontology/UtilitarianismDeontology/Utilitarianism
Deontology– The study of duties
that persons have toward one another.
– The categorical imperative of Immanuel Kant
Utilitarianism– The view that actions
or policies are to be morally evaluated according to the extent to which they promote happiness or well-being
Clinical BioethicsClinical Bioethics
Principles:– Beneficence (To do Good)– Nonmaleficence (Primum non nocere)– Justice (Fairness)– Autonomy (Self-determination)– Veracity (Truth telling)– Utility (The greatest good for the greatest
number)
Oath of MaimonidesOath of Maimonides
Code of ethics for the pharmacy profession. Altruism….”May the love for my art
actuate me at all time…”May neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind..”
Caring..”May I never see in the patient anything but a fellow creature in pain”
Code of Ethics for PharmacistsCode of Ethics for Pharmacists
Respect the values and abilities of colleagues and other health care professionals.
Service to individual, community, and societal needs
Seek justice in the distribution of health resources
Code of Ethics for PharmacistsCode of Ethics for Pharmacists
Respect for the covenantal relationship between patient and pharmacist.
Promotion of good for every patient in a caring, compassionate, and confidential manner.
Respect for the autonomy and dignity of patient. Act with honesty and integrity in professional
relationships Maintenance of professional competence
Elements of Informed ConsentElements of Informed Consent
Threshold requirement: competence Information requirements
– Information– Understanding
Consent requirements– Consent– Authorization
Problems/Ethical DilemmasProblems/Ethical Dilemmas
Veracity- Truth Telling, is deception every justified?
Privacy/Confidentiality, is failure to protect the privacy of the patient every justified?
Differences between obligations for privacy and for confidentiality
Tuskegee Study (1932-1972)Tuskegee Study (1932-1972)
Reasons given for continuing study– Long-term benefits for African-Americans– Contribution to scientific knowledge– Benefits for subjects (would receive other
medical treatment)– Subjects were not harmed– Treatment might harm (Jarische-Herxheimer)– Should not waste data collected
Tuskegee Study (1932-1972)Tuskegee Study (1932-1972)
Reasons given for not telling subjects the truth:– Subjects incapable of understanding– Scientists better equipped to determine what
would benefit the subjects (paternalism)– Better to sacrifice a few for the greater good of
the whole (utilitarianism)
Tuskegee Study (1932-1972)Tuskegee Study (1932-1972)
Reasons for breach of veracity tenet continued:– Subjects in the study were better off than those
not selected to participate.– Long-term scientific goals were of greater
importance than rights of an individual (Kant’s Categorical Imperative is breached)
Egregious Examples of Egregious Examples of Unethical ResearchUnethical Research
Tuskegee Syphilis Study (1932-1972) Nazi Experiments on Prisoners-WW II Willow Brook Study-1960’s Human Radiation Experiments 1950-1970 LSD Experiments 1930s Serratia marcescens experiments Bacillus subtilis experiments
Belmont ReportBelmont Report
Principles:– Respect for persons’ consent, privacy,
confidentiality– Beneficence (Benefits versus Risks)– Justice/Equality
45 Code of Federal 45 Code of Federal Regulations 46.111Regulations 46.111
Risks to subjects minimized Risks reasonable in relation to anticipated
benefits. Selection of subjects equitable Provision for safety monitoring Informed consent documented
45 CFR Part 46.11145 CFR Part 46.111
There is adequate provisions to protect the privacy of subjects and to maintain confidentiality of data
Where any of the subjects are likely to be vulnerable to coercion (“susceptible to kindness”) or undue influence, additional safeguards are incorporated to protect the subjects.
The Nuremberg CodeThe Nuremberg Code
The voluntary consent of the human subject is absolutely essential.
The experiment should be such as to yield fruitful results for the good of society.
Experiment based on results of animal experiments and knowledge of the natural history of the disease or problem
The Nuremberg CodeThe Nuremberg Code
The experiment should be conducted as to avoid all unnecessary physical and mental suffering and injury.
No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur;except in those experiments where the investigators serve as subjects.
The Nuremberg CodeThe Nuremberg Code
The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment.
Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death.
The Nuremberg CodeThe Nuremberg Code
The experiment should be conducted only by scientifically qualified persons.
During the course of the experiment the human subject should be at liberty to bring the experiment to an end (Intention to Treat Precepts)
The Nuremberg CodeThe Nuremberg Code
During the course of the experiment the scientist in charge must be prepared to terminate the experiment at any stage, if he/she has probable cause to believe, in the exercise of good faith, superior skill, and careful judgment that the continuation of the experiment is likely to cause injury, disability or death (Stopping Rules)
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