Tag: ethical codes

Bioethics Blogs

Not Just About Consent: The Ethical Dimensions of Research Methodology Knowledge in IRBs

Guest Post: Sarah Wieten

The recent article, “Some Social Scientists Are Tired of Asking for Permission” in the New York Times inspired a great deal of debate about the role of institutional research ethics board (IRB) oversight in social science, which some argue is in most cases unlikely to involve significant harm to participants.

While the role IRBs play in sociological research is being re-examined, the importance of IRB oversight for medical research was not similarly called into question. But what exactly does IRB oversight in medical research involve? Should these groups be content with assuring that patients and participants in medical research have provided informed consent? Or do they have wider duties? What is the relationship between methodologically rigorous science and ethical science?

The approval of research projects by IRBs is an integral part of the conduct of research in universities. IRBs ensure that all research follows key ethical guidelines and is pursued for good reason, and in doing so, they aim to keep patients and participants out of harm’s way. IRBs are important gatekeepers of institutional research, and serve as a check on the work of scientists, physicians, and others who are pursuing new knowledge.

We would assume then, that people serving on IRBs have a clear understanding of relevant research design. That way, they can check the research for ethical issues stemming from the methodology. They can also make sure that methodologically poor studies do not proceed, as this would be an unethical waste of resources (and would put participants at risk without a reasonable prospect of gaining reliable knowledge in exchange).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

What’s the Point of Professional Ethical Codes?

For a few reasons, I’ve been thinking a bit over the last few months about professionalism and professional codes.  In fact, that’s the topic that’s attracted most of my attention here since… oooh, ages ago.  I find the idea of a code of professional ethics troubling in many ways, but also fascinating.  And one of the fascinating questions has to do with what they’re for.

They can’t be meant as a particularly useful tool for solving deep moral dilemmas: they’re much too blunt for that, often presuppose too much, and tend to bend to suit the law.  To think that because the relevant professional code enjoins x it follows that x is permissible or right smacks of a simple appeal to authority, and this flies in the face of what it is to be a moral agent in the first place.  But what a professional code of ethics may do is to provide a certain kind of Bolamesque legal defence: if your having done φ attracts a claim that it’s negligent or unreasonable or something like that, being able to point out that your professional body endorses φ-ing will help you out.  But professional ethics, and what counts as professional discipline, stretches way beyond that.  For example, instances of workplace bullying can be matters of great professional and ethical import, but it’s not at all obvious that the law should be involved.

There’s a range of reasons why someone’s behaviour might be of professional ethical concern.  Perhaps the most obvious is a concern for public protection. 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Sentimentality in Medical Professionalism

By James Smith

As we navigate current and future health care transitions, I am skeptical that our conventional understanding of medical professionalism will assist us.  We have defined and organized medical professionalism into list of codes, behaviors, and collective “group-think” to serve as an aegis to transient threats to the central role of the medical practitioner in historic and contemporary healthcare.  Or at least physicians have.  Professionalism, as a movement in medicine, arguably had its inception in this country with the organization of the American Medical Association (AMA).  The AMA’s initial agenda included a proprietary defense to the threat of “irregular” practitioners—those from alternative medical education pathways.  The central role of physicians in modern healthcare has been eroded by payers, the government, and the healthcare systems in which physicians find employment.  Or so physicians think.  In response, physicians have conveniently deployed “professionalism” as a shield against these threats, and the general threat of commercialism in medicine.1 Furthermore, professionalism has been nuanced, expanded and rolled out as a discipline to be taught in medical education in order to protect and retain a collective identity, resistant to oversight or intrusive engagement from the outside.  The self-serving nature of the call for renewed professionalism and its incorporation into medical education is thinly veiled by the allure (and illusion) that it may actually be effective.  All we are accomplishing is the depersonalization the very nature of the relationship between healer and patient upon which we “profess” our social vocation…

Professionalism cannot be taught. Medical educators do not know how to teach professionalism2 and medical students do not like to be taught professionalism.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

On the ethics of machine learning applications in clinical neuroscience

By Philipp Kellmeyer

Dr. med. Philipp Kellmeyer, M.D., M.Phil. (Cantab) is a board-certified neurologist working as postdoctoral researcher in the Intracranial EEG and Brain Imaging group at the University of Freiburg Medical Center, German. His current projects include the preparation of a clinical trial for using a wireless brain-computer interface to restore communication in severely paralyzed patients. In neuroethics, he works on ethical issues of emerging neurotechnologies. He is a member of the Rapid Action Task Force of the International Neuroethics Society and the Advisory Committee of the Neuroethics Network.
What is machine learning, you ask? 
As a brief working definition up front: machine learning refers to software that can learn from experience and is thus particularly good at extracting knowledge from data and for generating predictions [1]. Recently, one particularly powerful variant called deep learning has become the staple of much of recent progress (and hype) in applied machine learning. Deep learning uses biologically inspired artificial neural networks with many processing stages (hence the word “deep”). These deep networks, together with the ever-growing computing power and larger datasets for learning, now deliver groundbreaking performances at many tasks. For example, Google’s AlphaGo program that comprehensively beat a Go champion in January 2016 uses deep learning algorithms for reinforcement learning (analyzing 30 million Go moves and playing against itself). Despite these spectacular (and media-friendly) successes, however, the interaction between humans and algorithms may also go badly awry.

The software engineers who designed ‘Tay,’ the chatbot based on machine learning, for instance, surely had high hopes that it may hold its own on Twitter’s unforgiving world of high-density human microblogging.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Are doctors who know the law more likely to follow it?

Guest Post: Ben White and Lindy Willmott, Australian Centre for Health Law Research

This was the question we considered in a recent JME article about the role of law in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. The short answer is ‘yes’. The longer answer is also ‘yes’ – although our results suggest that doctors may be acting in a way that complies with the law but not doing so because of the law.

Our article, which is part of a wider project, reports on survey results from 649 doctors from New South Wales and Victoria (Australia’s two most populous States). The doctors surveyed were from the seven specialties most likely to be making end-of-life decisions: emergency, geriatric, palliative, renal and respiratory medicine, medical oncology, and intensive care. We asked these doctors questions to determine their legal knowledge and we also asked them to respond to a scenario where following the law (by respecting an advance directive) conflicted with a more clinically oriented approach.

Compliance with the law was low with only 32% of doctors following the advance directive. Of interest was that doctors who knew the relevant law were more likely to comply with it and follow the advance directive than those doctors who did not know the law. Initially we thought that this could indicate that legal knowledge might lead to legal compliance. However, we then examined the reasons doctors gave for decision-making and also the factors they relied on to understand whether law was seen as important or not by doctors in their deliberations.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Moral Stress in Mental Health Practice and Research

Dr. Adam Fried

By: Adam Fried, Ph.D.

Mental health practice, assessment and research can be highly fulfilling, but also emotionally demanding. In recent years, the field of psychology has made a concerted effort to educate psychologists about the effects of various types of caregiver stress (including secondary traumatic stress and vicarious traumatization in which the professional internalizes or is otherwise personally affected by the trauma experienced by those with whom the professional works) on their mental health and professional work (Collins & Long, 2003; Figley, 2002). Extreme cases can lead to a phenomenon known as compassion stress/fatigue (Figley, 2002), which can often be accompanied by a decrease in professional self-efficacy and a reduced willingness to help (Figley, 2002; Newell & MacNeill, 2010).

Stress can take many forms. One type that has received increased attention occurs when professional, institutional or legal rules and constraints prevent the practitioner from doing what they believe is right or most beneficial for the client/patient. Known as moral stress, these experiences describe ethical and emotional impasses experienced by professionals who may feel unable to provide the assistance they believe is truly necessary to address the client’s issues while also maintaining appropriate boundaries and adhering to ethics codes and laws.

Originally developed within the nursing community (Jameton,1984), this type of stress has been studied across many “helping” professions, including social workers, psychologists, and palliative care providers. Within psychology, it isn’t difficult to imagine a variety of moral stress situations within practice, assessment and research settings, although the nature of moral stress may differ in terms of the role of the professional, the setting and the nature of the mental health condition or focus of intervention.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Drinking at Schiphol with the fount of bioethics

A couple of weeks ago, in an airport bar, I met the foundation of modern bioethics.

I was crawling back to London: he was heading to JFK.

‘I usually fly First’, was his opening, as we sat on those vertiginous stools. ‘So I’m usually in the Lounge. But it’s good to be reminded how the other half live.’ I was glad, for about a minute, to be part of his democratic education.

He’d had quite a start on me, and was several G & Ts down when I arrived. That might have loosened his tongue. Or perhaps, and probably, he was as keen when sober to talk obsessively, self-referentially and self-reverentially about himself. 

He was in derivatives, and had a view of Central Park from his apartment. ‘I live alone, but not alone, if you see what I mean.’ I did, but he spelt it out anyway. ‘I usually get through three or four a week.’ He saw my eyebrows rise. ‘Well’, he said: ‘I get what I want: they get what they want. Everyone wins.’

He’d always been a winner: in the markets, in bed, in life. At least since he’d left home, which had given him nothing. ‘I’m the boy from nowhere, you see. My parents are irrelevant. Always have been. Haven’t spoken to them for years. What I am is what I’ve made myself: what I’ve got is what I’ve taken with my own hands.’ He took my hands in his and squeezed them (rather weakly) to show me his elemental power.

The UK Parliament was about to discuss assisted suicide.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

There are things that even lawyers won’t do

Despite all the jokes there are, in fact, a lot of things that lawyers won’t do. Or at least shouldn’t do. In many jurisdictions qualified lawyers are subject to strict ethical codes which are self-policed, usually effectively, and policed too by alert and draconian regulatory bodies.

Is there any point, then, in law firms having their own ethics committees which would decide:

(a)        how the firm should deal with ethical questions arising in the course of work?; and/or

(b)       whether the firm should accept particular types of work, particular clients or particular cases?

A committee dealing with questions falling under (a) may be helpful. Colleagues routinely discuss such questions of professional ethics – sometimes seeking guidance from their professional regulatory bodies. On balance, a forum within a law firm that systematized that sort of discussion would be a good thing. The only plausible counter-argument would be that a requirement to discuss ethical issues in such a forum might lead to particularly ethically scrupulous individuals being bulldozed by the less scrupulous, or at least less ethically sensitive, corporate conscience. Individuals who might feel that their own professional consciences would compel them (for instance) to blow the whistle to the regulator about a particular practice might be wrongly reassured by the committee that this wasn’t necessary. In most contexts, however, this is unlikely to be a serious worry. Few solicitors would brazenly admit, to a minuted meeting, that they are proposing to do something ethically dodgy. The general effect is likely to improve ethical standards. Ethical dodginess thrives in dark corners and smoky rooms.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Chronic Pain — The Invisible Public Health Crises

Chronic Pain — The Invisible Public Health Crises

A Call for Moral Leadership

“I am an invisible man. No I am not a spook like those who haunted Edgar Allen Poe: Nor am I one of your Hollywood movie ectoplasms. I am a man of substance, of flesh and bone, fiber and liquids- and I might even be said to possess a mind. I am invisible, simply because people refuse to see me.”
– Ralph Ellison

Ralph Ellison’s famous novel, The Invisible Man, starts with this passage, which also reminds me of the problem of chronic pain. The Institute of Medicine (IOM) report, Relieving Pain in America, documented the more than 100 million Americans (almost 1 in 3 and surely someone whom you know and love) suffers from chronic pain, at an economic cost of $6 billion and an incalculable psychological cost. We named pain as a “disease” because of its profound effects on the brain and its interference with multiple domains of the quality of life of sufferers. The committee identified chronic pain as a public health problem, given the sheer numbers affected, and the opportunities to intervene to prevent acute pain from becoming chronic pain. However, the report is now almost four years old, and it is fair to say has not really moved the needle in doing what we implored in the IOM report—“changing the way in which pain is judged, managed and perceived.” Why is that?

Because pain is subjective — and therefore difficult to measure by the usual medical tests — it is often doubted.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Marketing Practices of Canada’s ‘Top Sex Crime Lawyers’

Elaine Craig argues that some lawyers need to change the way they talk about sexual assault

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Sexual violence is an indisputable threat to the physical and mental health of Canadian women. The outcry in response to the discovery of rape chants on university campuses, the use of social media to harass and re-traumatize victims of sexual violence, and the allegations against high profile public figures, such as CBC radio host Jian Ghomeshi, has focused enormous public attention on the issue of sexual violence. In fact, the Premier of Ontario recently took the unusual step of reminding defence lawyers that victims of sexual assault cannot be interrogated for the way that they dress or for their sexual history. However, despite significant reforms to improve the criminal law’s response to sexual harm, conviction rates have not risen, and reporting rates remain dramatically lower than for some other types of violent crime. Sexual assault complainants continue to identify a lack of faith in the judicial system as one of the main reasons not to report their victimization.

LADY JUSTICE 2

An important aspect of the social problem of sexual harm involves the legal profession’s response to, and discourse surrounding, allegations of sexual harm. It matters how lawyers, who serve as significant actors in the criminal justice system, describe allegations of sexual violence, portray the law of sexual assault, and explain the available defences to charges of sexual assault. Today most lawyers have websites that advertise their legal services online. Examination of these websites offers a window into the narratives about sexual assault that some defence lawyers construct for their clients.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.