Ethics of Pandemic control + outsourcing of clinical trial + conflict of interest and international epidemiology - 2.1 + 2.4 + 2.17

Question 1

What does utilitarianism mean?

Answer 1

The ethically correct action is that which brings about maximal benefit

Question 2

What are the criticisms of utilitarianism?

Answer 2

Relies on weighing up of the consequences which can be hard to predict in complex situations
Based on premise of maximising overall benefit, risks overriding the interests of the individual

Question 3

What is the definition of autonomy?

Answer 3

Being free to make own choice

Important for human flourishing

Question 4

When is it possible to limit an individual’s autonomy?

Answer 4

When there is harm to others but what counts as a sufficient harm to others?
E.g. For a drug, private purchase may result in some people not taking the drug appropriately or that it may limit the supply of the drug to others sufficient justification for limiting the individuals to decide to spend their own money on that drug

Question 5

What is a right?

Answer 5

A universal moral entitlement and cannot be taken away

The State has an obligation to uphold our rights but this is not unlimited

Question 6

What is solidarity?

Answer 6

Sense of standing together when individuals/community are threatened
State decisions and actions should promote and nurture solidarity

Question 7

What does a fair process require?

Answer 7

Wide consultation
Accountability + transparency
A route for appeal

Question 8

What does justice require?

Answer 8

A fair distribution of benefits + burdens

Question 9

What is social justice?

Answer 9

Minimise burdens imposed by social inequalities
E.g. policy will need to address why people in lower socio-economic groups are less likely to gain access to timely healthcare + less likely to engage with public health initiatives

Question 10

What are the 4 main principles of bio-ethics?

Answer 10

Autonomy - patient must have autonomy of thought, intention + action when making decisions
Justice - burdens and benefits of new or experimental treatments must be distributed among all groups in society equally
Non-maleficence - procedure does not harm pt involved or others in society
Beneficence - procedure provided with intent of doing good for the patient involved

Question 11

What was the Nuremberg Trials?

Answer 11

12 trials accusing 23 German Physicians + scientists for all they did during World War 2
1945-49
Claimed that it was for the good of society and there was ‘voluntary consent’

Question 12

What is the Declaration of Helsinki?

Answer 12

Ethical principles for Medical Research involving Human Subjects developed by the World Medical Association (WMA)
Duty of the physician in medical research to protect the life, health, privacy + dignity of the human subjects
Essentially informed consent

Question 13

What example demonstrated a breach in the Declaration of Helsinki?

Answer 13

The Tuskegee Study (1932-72)
Study looking at natural history of untreated syphilis whereby the African-American men were told they were receiving free health care from the US government
128 died from syphilis
Told that it would only last 6 months but lasted 40 years
None were treated with penicillin even after it was successfully proven to be effective

Question 14

Give an example whereby informed consent was not taken/given

Answer 14

Kano trial

Question 15

What are the 9 areas that should be communicated for informed consent for research trial participation?

Answer 15

Purpose of the study, study design + protocol
Reasonably forseeable risks + discomforts
Benefit
Disclosure of alternative procedures/treatments
Confidentiality of records
Compensation for treatment + injury
Contact information
Voluntary participation
Participants should understand the information given

Question 16

What is the definition of conflict of interest?

Answer 16

Compromise of a person’s objectivity when that person has a vested interest.

Occurs when the person could benefit financially or in other ways. Conflicts of interest are not limited to research settings, nor to the health sciences

Question 17

Why is conflict of interest important to research?

Answer 17

Research needs to be focused on the primary goal and not distorted by secondary goals - integrity

Question 18

What are the pathways by which conflict of interest can distort results?

Answer 18

Motivations usually the pursuit of benefits
Career advancement or profits
Support (hidden or overt) of a specific scientific hypothesis, theory or political agenda

Question 19

What are the barriers to policy change related to conflicts of interest?

Answer 19

Vested interests
Organised denialism
Political short-termism
Divided public opinion
Perception that change is expensive + difficult