Transcript Chapter 12: Ethical and Legal Issues in Epidemiology

Chapter 12: Ethical and Legal
Issues in Epidemiology
Introduction
• Question of ethics arises when our conscience
and thoughts fail to agree.
• Greatest unethical disasters have happened
because of discrimination.
– Based on race, gender, color, accent, religion,
citizenship
• Unethical incidences continue to occur.
Unforgivable History of Humans
• Torture and experimentation carried out by
Nazis let to development of Nuremberg Code.
• Nuremberg Code failed to prevent some
unethical studies since.
– Secret radiation experiments carried out by
federal agencies
– Testing of drugs by drug companies in one country
for use in another country
World Medical Association Declaration
of Helsinki
• Developed in 1964
• Protects rights of humans involved in medical
research
• Research must be conducted for either
diagnostic or therapeutic benefits
• Principles are regularly reviewed and updated
Belmont Report
• Principles applying to research subjects:
– Respect for persons
• Includes concepts of autonomy and protection from
diminished autonomy
– Beneficence
• Includes concepts of do not harm and maximize the
benefits
– Justice
• Includes concept of fairness
Third World as a Scapegoat
• Drug companies conduct studies in Africa that
breach the Declaration of Helsinki.
– High incidence of HIV and of poverty attracts
studies.
• Outmoded ways of dealing with public health
continue, such as chlorinating water to
contain spread of cholera.
– Outbreaks have become infrequent, and chlorine
causes bladder cancer.
Ethical Issues Associated With Genetic
Testing
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Informed consent
Confidentiality
Privacy
Discrimination
Ethical Issues Associated With Public
Health Data
• Electronic medical records contain private
information.
– May be disclosed in some circumstances.
– Can even leak out through hard drives on recycled
photocopy machines .
• In some countries health care is controlled by
the government.
Honorary Coauthorship
• Pressed by some department heads in
academia and healthcare facilities on junior
faculty and researchers
• Difficult to deal with
• Research has shown that the quality of
research is diluted.
Cyberspace Research and Ethical
Dilemmas
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Informed consent without face-to-face contact
Accuracy of the information gathered
Technological issues
Access to e-mail identifications
Biases associated with qualitative research
Ethical Issues With Research Involving
the Elderly
• Informed consent process is interfered with
by:
– Confusion
– Dementia
– Cultural issues
• Privacy may be violated.
• Institutional review boards should protect
elderly from harm and abuse.
Controversial Public Health Issues
• Autism was incorrectly linked to MMR vaccine
through a non-scientific study.
– Negatively impacted autistic children’s health by
increasing susceptibility to deadly viruses
• Quarantine
– Applied to some diseases
– Nurses should understand its limits and
consequences.
Traumatic Experience of Natural
Disasters
• Decisions made by public health professionals
during disaster should be based on principles
of:
– Autonomy
– Beneficence
– Justice
• 2010 Gulf of Mexico oil spill
– Large, unfortunate opportunity to study effects of
a disaster
Resources for Public Health Ethics
• With your research studies:
– Understand global impacts of research question.
– Address ethical and legal questions associated
with study.
– Honor the public trust placed in you.
• The textbook lists some available resources on
ethical issues.
Legal Epidemiology
• Epidemiologists play important role in
identifying evidence of causation in legal
issues.
• Statistically significant studies may help legal
decision-making process.
• Epidemiological study conclusions can be
misused.