Transcript Ethics for Transfusion Medicine Residents

Ethics for Transfusion
Medicine Residents
Dr. Jerry Growe
Prof. Michael McDonald
Learning objectives
 Identify
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Some ethical issues in transfusion medicine
Methods for resolving ethical issues
 Offer
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and discuss
resources
Ethical framework
• http://www.ethics.ubc.ca/people/mcdonald/decision
s.htm
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Ethics lit search
• http://bioethics.georgetown.edu/
Part I. What is ethics?
 Ethics
as the systematic study of human
conduct and moral judgement, including
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good/bad,
right/wrong
virtue/vice
 Critical
reflection on moral beliefs and
practices
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What are people’s moral beliefs?
What choices should we make?
Moral psychology (Rest)
4 Components of Moral Behaviour
1.
Ability to recognize a situation as having a moral
component
2.
Ability to make a judgement as to which action is
right, fair, just, appropriate
3.
Commitment to morally appropriate action
4.
Possession of appropriate personal qualities
(perseverance, courage) to carry out morally
appropriate actions
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James Rest
Acquisition of moral values
 Many
values are “caught” rather than
“taught”
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Importance of peers and workplace
Socialisation and acculturation
Life experiences
 Reflective
engagement
Ethical judgements
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Centre on important values
Based on reason, not authority
Override self-interest to assure mutual benefit
Based on impartial considerations
Special words and emotions
“All things considered judgements”
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Not optional add-on judgements
Integrative or holistic
Ethical judgements & principles
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Ethical judgements involve a dual test:
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“Are the means acceptable?” AND
“Are the ends worthwhile?”
Consensus principles in bioethics
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Treat people with respect
Do no harm
Do good
Act fairly
Be caring
Part 2. Ethics & Transfusion
 Clinical
practice ethics centres on patient
care
 Requires
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Patient (or guardian) consent
Fairness to other patients
 Within
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institutional parameters
Licensing, medical appointment, general
health care system authorisation
Clinical Case #1
You received a phone call from a donor
asking why a "Coombs" test, (DAT), or
an HTLV test was done and reported
positive to her. Should the donor be
surprised? Did the donor truly give
informed consent to the test?
Clinical case 2
The Special Services Nurse has brought cases to
you on several occasions as he has wondered
about your colleague's interpretation of the
medical data, and the acceptance of the
donors involved. You also have been informed
through the grapevine that he frequently is
unavailable by pager when on call and, as a
result, three plateletpheresis donors have been
disqualified. What should you do?
Research ethics basics
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Research involving humans is a privilege, not a
right!
 Those who conduct research involving humans
must meet norms for ethical research
 The onus is on those who conduct, house or
sponsor research to show these norms are met.
Three central questions
Does the research meet relevant
scholarly/scientific standards?
1.
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Bad science is bad ethics
Is the science honestly done and accurately reported?
Will the likely net benefits of the research will
outweigh overall harms?
Does the research respect the rights of the
research subject, including
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Protection from undue harm &
Informed consent?
Norms for clinical research
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Socially valuable research
Scientifically sound research
Fair subject selection
Favourable risk-benefit ratio
Independent review by an REB
Informed consent
Respect for actual and potential research subjects
in the conduct of research
Emmanuel et al. JAMA 2000
Research case
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A physician-researcher you know at the
provincial cancer agency asks that you provide
her with left-over blood from routine medical
tests of patients with a certain type of tumour in
order to test a research hypothesis she has
about tumour growth. She also asks that you do
a chart review of these patients. She offers you
co-authorship on the resulting publication. What
should you do? Are there are any special rules
and procedures to follow with the use of blood
for research purposes?