Bioethics Flashcards
The study of ethical and moral implications of
medical research and practice
BIOETHICS
A branch of philosophy
Rules of behavior based on ideas about what is
morally good and bad
ETHICS
2 general ethical principles
- Respect for autonomy
- Protection of persons with impaired or diminished
autonomy
Requires that those who are capable of deliberation
about their persona; choices should be treated with
respect for their capacity for self-determination
Respect for autonomy
prominent in cases with clinical trials, vulnerable
population. Requires that those who are dependent or vulnerable be afforded security against harm or
abuse
Protection of persons with impaired or diminished
autonomy
their job is to review drugs that are not yet
released in the market
Ethical Committee
What place where administrator is the one who asks for consent: a question of ethics
Nursing Homes
4 Research Hierarchy
- Animal study
- Stage 1: 10-20 healthy participants, dosages
- Stage 2: 300-800 patients with disease for efficacy
- Stage 3: more than a thousand participants
Paying someone to join a study is ____
unethical
Ethical obligation to maximize benefits and minimize harms Gives rise to norms requiring that the risks of research be reasonable in the light of the expected benefits
Beneficience
Soundness of research design, must be technically
sound. If not technically sound, it’s not ___
ethically sound
Fully recognized ethics
committee by the Philippine Ethics Board, Forum for
Ethical Review for Asia and Western Pacific
WVSU Ethics committee
drug with minimal harm, minimal side
effects (nausea, headache, vomiting), but must undergo
another trial for covid-19; cost – 8,000 per dose, 3 doses
per day for 10 days = 240 000 for free for each patient
Remdesivir
Solidarity trial sites in the Philippines
Cebu – Chong Hua Hospital and WVSU Medical Center
Obligation to treat each person in accordance to what is morally right and proper. To give each person what is due him/her
Justice
Justice in research ethics is often referred to as
distributive justice
Philippines was chosen to be a testing site yet
the company decides not to market the drug in the Philippines. (Unethical) is an example of
distributive justice
any situation wherein the pregnant woman’s interests or well-being contradicts the interests or benefit of the fetus, as defined by the physician.
Fetal-maternal conflict
testing for any abnormalities in the
fetus before birth. Ethical issues may arise when complications are present and decisions have to be made regarding the fate of the
fetus
Prenatal diagnosis
involve the amount of care or medical attention that should be given to terminally ill
patients
End of life issues
An example is resuscitation on a terminally ill
patient.
END OF LIFE ISSUES
is often based on best interest principle (chance of survival, pain of attempted resuscitation, subsequent benefits or burdens).
DECISION TO RESUSCITATE A NEONATE
Embryos are destroyed in the process of stem cell line derivation used for stem cell therapy that is usually given to adults.
STEM CELL THERAPY
5 COMMON ETHICAL ISSUES IN PRACTICE
- Fetal maternal conflict
- Prenatal diagnosis
- End of life issue
- Decision to resucitate a neonate
- STEM cell therapy
7 Ethical issues in medical research
- validity and scientific soundness
- Informed consent
- Confidentiality
- Voluntariness
- Compensation
- Vulnerable population
- Equitable distribution of burdens and benefits
Research not scientifically sound is not ethical
validity and scientific soundness
Patients or participants should be given appropriate
information about the treatment so they may make a
voluntary choice to accept or refuse it.
INFORMED CONSENT
can informed consent be translated?
There is a translation for informed consent
Questions often asked about confidentiality
→ Who will have access to the information gathered?
→ How long will the information be kept?
→ What is the method of destruction?
Information provided by the participants should be kept private and the anonymity of the subjects must be
respected.
Voluntariness
Just compensation must be provided to participants who suffered injury as a result of participating in the study.
Compensation for injuries
For example, subject met an injury on the way to the place where the study will be conducted. Researcher must pay for medical expenses.
COMPENSATION FOR INJURIES
In the case of research involving minors, parent or guardian should sign the consent form while minors can
sign assent form:
Vulnerable population
15-18 yrs. old
→ 12-14 yrs. old
→ 8-12 yrs. old
Should sign the assent form; Should sign less detailed assent form; No assent form but should be
consulte
Impoverished population is prone to _____
Since they agree to participate because they are given
money.
inducement
Reasonable compensation is not more than Php____
1500
If both male and female are tested, both should also receive the benefits of the study
EQUITABLE DISTRIBUTION OF BURDENS AND BENEFITS
Sulfanilamide drug was usually given in powder form. They thought it would yield better results in elixir form. Solvent used for making the elixir caused the adverse effects of the drug
SULFINAMIDE DISASTER
which is a set of ethical principles for medical studies using human subjects.
Nuremberg code
The Thalidomide tragedy led to the formation of
Kefauver-Harris
Amendments” or the Drug Efficacy Amendment of
1962
first international guideline to be produced, and a key document on which many subsequent regulations have been based
Nuremberg Code
Three key/salient principles of Nuremberg Code
- Subjects should give their voluntary consent
- Experiments should be as such as to yield fruitful results for the good of society
- Participants should be protected and experiment
should avoid all unnecessary physical and mental
suffering and injury.
Adopted by the World Medical Association (WMA) in 1964 in response to the findings
of the Nuremberg Trials
Declaration of Helsinki
Statement of ethical principles for medical research
involving human participants, including identifiable
human material and data
Declaration of Helsinki
Purpose: Understand Disease, improved interventions. Human Participant necessary. Primacy of Patient’s best interest: health, well-being rights
Declaration of Helsinki
holds that “Well-being of research participants should take precedence over the interests
of science and society”
Principle 6 of the Declaration of Helsinki
holds that “It is the duty of the researcher to protect the life, health, dignity, right to self-determination, privacy, and confidentiality of the
research participants and to safeguard scientific integrity”
Principle 11 of the Declaration of Helsinki
Covers every aspect of clinical research since its purpose is to protect the rights of every subjects
HELSINKI CONTENTS
Good clinical practice certification is one of the many in the
Helsinki Content
Provides public with assurance that “the rights and
safety and well-being of trial participants are protected
and that the data and results are credible”
GOOD CLINICAL PRACTICE GUIDELINES
7 CONTENTS OF GOOD CLINICAL PRACTICE GUIDELINES
- Principles
- Research ethics committees
- Investigator
- Sponsor
- Clinical trial protocol and amendments
- Investigator’s brochure
- Essential documents for the conduct of a clinical trial
5 EMPHASIS OF GOOD CLINICAL PRACTICE GUIDELINES
- Follows ethical standards
- Information on protocol, investigators, and product are adequate and available
- Product manufactured handled and stored appropriately
- Protocol compliance
- Conduct recorded and reported accurately;
3 WHO STANDARDS AND OPERATIONAL
GUIDANCE
- Research ethics review system
- Research ethics committees:
- Researchers and their obligations
SCOPE OF HEALTH-RELATED RESEARCH
Biomedical, Behavioral, Social Science, and
Epidemiologic
3 SYSTEMS APPROACH FOR THE PARTICIPANTS AND PROTECTION PROGRAMS
- Monitor quality research
- Make iperation transparent
- Comply with national government
National Research Act creating the National Commission
for the Protection of Human Subjects of Biomedical and
Behavioral Research
BELMONT COMMISSION
3 principles of belmont Commission
- Respect for person
- Beneficience
- Justice
Requirement to acknowledge autonomy
Requirement to protect those with diminished
autonomy
Respect for persons
Do not do harm
Maximize possible benefits and minimize
possible harm
Sometimes expressed as a separate principle,
nonmaleficence (do no harm)
Beneficience
o To each person an equal share
o To each person according to individual need
o To each person according to individual effort
o To each person according to societal
contribution
o To each person according to merit
Justice