Has Emergency Medicine Research Benefited Patients? An Ethical Question

From an ethical standpoint, the goal of clinical research is to benefit patients. While individual investigations may not yield results that directly improve patients’ evaluation or treatment, the corpus of the research should lead in that direction. Without the goal of ultimate benefit to patients, such research fails as a moral enterprise. While this may seem obvious, the need to protect and benefit patients can get lost in the milieu of clinical research.Many advances in emergency medicine have been based upon the results of research studies conducted both within the specialty and by others outside of the field. But has this research benefited patients? Has it followed the Hippocratic commitment “to do good or at least do no harm”? The answer is: yes, and no. This paper attempts to demonstrate this: first by citing advances from applied research that have benefited emergency department patients over the past three decades, and follows with some aspects of emergency medicine research that makes one question both its safety and its efficacy. While enormous gains have been made in patient care as a result of emergency medical research, ethical considerations complicate this rosy picture, and point to future areas of concern for researchers.Some aspects of clinical research and research oversight fall short of meeting the ethical standards of safety and patient benefit. Research agendas are still driven largely by the availability of funds, both from private industry and from government agencies. Many vital patient groups are harmed by omitting or sorely under-representing them as research subjects, most notably those that are critically ill and injured. Finally, questions still arise about clinical researchers’ fiduciary responsibility to their subject-patients. Even more important than the institutional safeguards, such as the Institutional Review Boards, is the individual researcher’s moral compass, which must serve to protect the subject-patients of clinical research.Overall, emergency medicine research has been and continues to be a moral endeavor. Perhaps the greatest moral lapse has been the lack of attention to key populations within emergency medicine research, and the patients most needing acute intervention are the ones who suffer.     

Nuance, Complexity, and Context: Qualitative Methods in Genetic Counseling Research

Because of its potential for capturing complexity and process and its focus on communicating the meaning in human action, qualitative research is rapidly gaining acceptance in a wide variety of disciplines. Various qualitative approaches to research support its potential usefulness in genetic counseling research. Formulation of research questions and selection of appropriate qualitative methods are the first step. Interviewing, narrative analysis, focus groups, ethnography/participant observation, and participatory action research are only some of the most popular techniques that may be suitable in various situations. Processes of evaluation, analysis, and even ethical issues often differ somewhat from quantitative research. This article discusses these issues and the potential value of qualitative methods for research related to genetic counseling.     

Empirical Research on Ethical Issues in Pediatric Research

Although there is usually agreement about the ethical principles that should govern research on children, there may be little agreement on how those principles should be interpreted into research procedures in some instances. Empirical research on ethical issues that arise in research on children can often elucidate ways to improve on existing research practices and ways to resolve debates about best practices. Following in the success of evidence-based medicine, evidence-based ethical problem solving in human research can enable investigators to avoid such poor alternatives as doing nothing, endlessly debating, or acting on the basis of hunch or time-honored but dubious research practices. A variety of approaches to evidence-based ethical problem solving are illustrated in this article.     

Both Sides of the Coin: Randomization from the Perspectives of Physician-Investigators and Patient-Subjects

Randomization is the “gold standard” design for clinical research trials and is accepted as the best way to reduce bias. Although some controversy remains over this matter, we believe equipoise is the fundamental ethical requirement for conducting a randomized clinical trial. Despite much attention to the ethics of randomization, the moral psychology of this study design has not been explored. This article analyzes the ethical tensions that arise from conducting these studies and examines the moral psychology of this design from the perspectives of physician-investigators and patient-subjects. We conclude with a discussion of the practical implications of this analysis.     

Attentional control in depression: A translational affective neuroscience approach

Translational research refers to the application of basic science to address clinical problems and acquire knowledge that can be used to guide and refine clinical practice. This special issue of Cognitive, Affective, & Behavioral Neuroscience seeks to explore and integrate some of the most promising findings offered by recent cognitive and affective neuroscience studies in hopes of filling the gap between basic and applied research, thereby heightening our understanding of vulnerability for depression. The studies presented in this special issue focus specifically on attentional processes. We solicited contributions from leading researchers involved in basic cognitive and neuroscience research investigating processes underlying depression-related disturbances in emotion processing. In this introductory article, we present an integrative overview to demonstrate how these specific contributions might be valuable for translational research.     

Ethical Problems Inherent in Psychological Research based on Internet Communication as Stored Information

This paper deals with certain ethical problems inherent in psychological research based on internet communication as stored information. Section 1 contains an analysis of research on Internet debates. In particular, it takes into account a famous example of deception for psychology research purposes. In section 2, the focus is on research on personal data in texts published on the Internet. Section 3 includes an attempt to formulate some ethical principles and guidelines, which should be regarded as fundamental in research on stored information.     

The Nature and Significance of Behavioural Genetic Information

In light of the human genome project, establishing the genetic aetiology of complex human diseases has become a research priority within Western medicine. However, in addition to the identification of disease genes, numerous research projects are also being undertaken to identify genes contributing to the development of human behavioural characteristics, such as cognitive ability and criminal tendency. The permissibility of this research is obviously controversial: will society benefit from this research, or will it adversely affect our conceptions of ourselves and each other? When assessing the permissibility of this research, it is important to consider the nature and deterministic significance of behavioural genetic information. Whilst todate there has been much discussion and debate about the properties of genetic information per se and genetic determinism, this has not been applied to behavioural genetic research and its ethical implications. Therefore, this paper elucidates how behavioural genetic information can be distinguished from other types of genetic and non-genetic information and also synthesises the determinative significance of genetic factors for the development of human behavioural traits. Undertaking this analysis enables the ethical issues raised by this research to be debated in an appropriate context and indicates that separate policy considerations are warranted.

     

Ethical Requirements and Responsibilities in Video Methodologies: Considering Confidentiality and Representation in Social Justice Research

In recent years, psychologists have begun to use video more frequently in qualitative research, in particular, within research on social justice. The non‐confidential nature inherent in video, however, raises new ethical challenges for the field of psychology to address. Building upon a growing literature on video‐based research, in this article, we use an illustrative case study to examine how researchers' sense of ethical responsibility can find guidance from, clash against, or fill gaps left by extant federal and disciplinary ethical requirements. We focus specifically on issues of confidentiality and representation, highlighting the challenges and possibilities that video creates in relation to participants' power, dignity, and participation and arguing that psychologists must systematically engage questions about ethical responsibilities throughout the design and implementation phases of a research project. In doing so, psychologists, their community partners, and students will be better able to articulate and problematize their assumptions and intentions regarding video work.     

Informed consent and the use of placebo in poland: Ethical and legal aspects

The concept of informed consent was one of the most fruitful ideas that deeply changed the relationships between physicians and their patients from paternalism to respect for the personal autonomy of subjects needing professional medical care. The great progress in medicine, also involving the pharmaceutical industry, has created an increasing need to perform different clinical and experimental trials. The evolution of clinical research in the last decades has influenced strongly the design of these studies. One of the most important changes in this field has been the use of placebo groups in double-blind controlled studies. The controversies have involved not only the use of placebo when standard or proven treatment was available, but also some specific problems concerning the procedure of obtaining informed consent in such trials. This paper briefly presents the evolution of informed consent in Poland as well as different ethical and legal problems concerning informed consent and the use of placebo controls in clinical trials. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

Toward an Ethical Reflective Practice of a Theory in the Flesh: Embodied Subjectivities in a Youth Participatory Action Research Mural Project

The focus of this paper is to demonstrate how embodied subjectivities shape research experiences. Through an autoethnography of my involvement in a Youth Participatory Action Research (YPAR) after‐school program with low‐income and working‐class youth of Color from predominantly Latinx communities I examined my embodied subjectivities, via an ethical reflective practice, as these surfaced in the research context. Autoethnography is presented as a tool to facilitate an ethical reflective practice that aligns with heart‐centered work. Drawing from an epistemology of a theory in the flesh (Anzaldúa & Moraga, 1981), embodied subjectivities are defined by the lived experiences felt and expressed through the body, identities, and positionalities of the researcher. The article concludes with implications for the development of community psychology competencies that attend to the researcher's embodied subjectivities.     

Using empirical data to inform the ethical evaluation of placebo controlled trials

There has been considerable debate about the ethical acceptability of using placebo-controls in clinical research. Although this debate has been rich in rhetoric, considering that much of this research is predicated upon the assumption that data from this research is vital to clinical decision-making, it is ironic that researchers have introduced little data into these discussions. Using some published research concerning the use of placebo-controls in clinical research in hypertension and psychiatric drug trials, I suggest some ways that such data might be incorporated into the ethical analysis concerning placebo use in clinical trials. This approach promises to be important for enhancing conceptual and scientific understanding as well as public policy decision-making. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.     

Ethical Considerations of Screening and Early Intervention for Clinical High-Risk Psychosis

Research on individuals at clinical high risk for psychological and physical disorders has grown exponentially in recent years, with a variety of new screening tools and early intervention techniques being implemented. One recent example is Attenuated Psychosis Syndrome, a diagnosis for individuals who are at clinical high risk for psychosis, which was recently included in Section III of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Given the focus on prevention at early stages, at-risk individuals will continue to be a topic of significance not only in psychosis research but also in other illnesses. This document provides a comprehensive summary of the ethical dilemmas that clinicians or researchers may encounter in this domain, and possible actions consistent with the current Canadian Code of Ethics for Psychologists. We use clinical high risk for psychosis and the Canadian Code of Ethics for Psychologists as a way to illuminate these ethical issues; however, application to other jurisdictions and disciplines, as well as other high-risk populations, is also of relevance.     

“But We Want to Work”: The Movement of Child Workers in Peru and the Actions for Reducing Child Labor

The program Edúcame Primero (Educate Me First) is an evidence‐based practice for eradicating child labor that has been applied with positive results in Colombia, Peru, and several Central American countries. In this article, we describe the difficulties of implementing the program in two poor areas of Lima (Peru) between 2014 and 2016. Specifically, we discuss three ethical challenges faced during the implementation of the program: (a) the existence of a movement of working children that defends the right of children to work; (b) the polarization of some community‐based associations and government institutions on how to deal with the problems of working children; and (c) the use of network indicators in the evaluation of the community's level of cohesion. Taking the Code of Ethics of the General Council of Associations of Psychologists in Spain as a guide, we adopted a consensus approach in planning and research design, combining different criteria of value with the participation of different stakeholders. The implementation of the program in Peru gave preference to developing skills in children over changing attitudes in relation to child protection, although the intervention openly declared its aims when engaging institutions and families. Finally, we address how social network research places special ethical demands on conventional ethical standards. Our experience with this project shows the importance of acting as a bridge between different stakeholders and assessing how all of them benefit from the intervention.     

Getting Beyond Form Filling: The Role of Institutional Governance in Human Research Ethics

It has become almost a truism to describe the interaction between research ethics committees and researchers as being marred by distrust and conflict. The ethical conduct of researchers is increasingly a matter of institutional concern because of the degree to which non-compliance with national standards can expose the entire institution to risk. This has transformed research ethics into what some have described as a research ethics industry. In an operational sense, there is considerable focus on modifying research behaviour through a combination of education and sanctions. The assessment of whether a researcher is ‘ethical’ is too often based on whether they submit their work for review by an ethics committee. However, is such an approach making a useful contribution to the actual ethical conduct of research and the protection of the interests of participants? Does a focus on ethical review minimise institutional risk? Instead it has been suggested that ethics committees may be distorting or frustrating useful research and are promoting a culture of either mindless rule following or frustrated resistance. An alternative governance approach is required. There is a need for a strong institutional focus on promoting and supporting the reflective practice of researchers through every stage of their work. By situating research ethics within the broader framework of institutional governance, this paper suggests it is possible to establish arrangements that actually facilitate excellent and ethical research.     

Ethical Perceptions of Field Sales Personnel: An Empirical Assessment

Much research attention has been directed over the past twenty-five years to ethical issues in marketing. One area of marketing that is gaining research interest is the selling arena. Despite the extant literature on selling ethics, few studies have focused on identifying situations that pose ethical problems for field sales personnel. This paper reports results of an investigation that examined salespeople's perceptions concerning what selling situations or practices are ethical questions, what situations are presently addressed by company policies, and what situations should be addressed by company policies. Findings reveal that salespersons seemingly are desirous of receiving more management guidance than they currently are receiving regarding their ethical concerns. Implications for managers and researchers are provided.     

The senior therapist's grandiosity: Clinical and ethical consequences of merging multiple roles

Grandiose senior therapists who knowingly foster treatment relationships that run counter to the wisdom and ethics of the field of psychotherapy can do harm to their patients. When practitioners merge the boundaries of treatment they simultaneously violate professional ethical codes and violate the frame of the analysis. Multiple role relationships often exploit patients' dependency while gratifying the narcissism of the senior therapist. The focus of this paper will be to explore the motivation and personality of senior therapists who are socially involved with their patients. The convergence of ethical and clinical problems related to multiple role relationships will be addressed also. Professionals may be able to resolve the problem through group process.     

Developing an ethical code for engineers: The discursive approach

From the Hippocratic Oath on, deontological codes and other professional self-regulation mechanisms have been used to legitimize and identify professional groups. New technological challenges and, above all, changes in the socioeconomic environment require adaptable codes which can respond to new demands. We assume that ethical codes for professionals should not simply focus on regulative functions, but must also consider ideological and educative functions. Any adaptations should take into account both contents (values, norms and recommendations) and the drafting process itself. In this article we propose a process for developing a professional ethical code for an official professional association (Colegio Oficial de Ingenieros Industriales de Valencia (COIIV) starting from the philosophical assumptions of discursive ethics but adapting them to critical hermeneutics. Our proposal is based on the Integrity Approach rather than the Compliance Approach. A process aiming to achieve an effective ethical document that fulfils regulative and ideological functions requires a participative, dialogical and reflexive methodology. This process must respond to moral exigencies and demands for efficiency and professional effectiveness. In addition to the methodological proposal we present our experience of producing an ethical code for the industrial engineers’ association in Valencia (Spain) where this methodology was applied, and we evaluate the detected problems and future potential. An earlier version of this paper was presented at the 2005 conference, Ethics and Social Responsibility in Engineering and Technology, Linking Workplace Ethics and Education, co-hosted by Gonzaga University and Loyola Marymount University, Los Angeles, CA, USA, 9–10 June 2005.     

Being, Doing, and Knowing: Developing Ethical Competence in Health Care

There is a growing interest in ethical competence-building within nursing and health care practising. This tendency is accompanied by a remarkable growth of ethical guidelines. Ethical demands have also been laid down in laws. Present-day practitioners and researchers in health care are thereby left in a virtual cross-fire of various legislations, codes, and recommendations, all intended to guide behaviour. The aim of this paper was to investigate the role of ethical guidelines in the process of ethical competence-building within health care practice and medical research. A conceptual and critical philosophical analysis of some paragraphs of the Helsinki Declaration and of relevant literature was performed. Three major problems related to ethical guidelines were identified, namely, the interpretation problem (there is always a gap between the rule and the practice, which implies that ethical competence is needed for those who are to implement the guidelines); the multiplicity problem (the great number of codes, declarations, and laws might pull in different directions, which may confuse the health care providers who are to follow them); and the legalisation problem (ethics concerns may take on a legal form, where ethical reflection is replaced by a procedure of legal interpretations). Virtue ethics might be an alternative to a rule based approach. This position, however, can turn ethics into a tacit knowledge, leading to poorly reflected and inconsistent ethical decisions. Ethical competence must consist of both being (virtues) and doing (rules and principles), but also of knowing (critical reflection), and therefore a communicative based model is suggested.