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Notes from 2/12: Principles of Conduct

E. Thatcher

See Boylan & Brown, Ch. 2 and the handout of professional ethics codes.

What is a professional code?

List of common abuses

Guidelines of behavior

Link to theories of ethics & behavior


Physicians: Hippocratic Oath- origins in ancient Greece

Do all swear to it?

Many versions: key points

1. Duty to profession & community of professionals

2. Duty to patients- "Do no harm", help to best of ability, moral, confidential


Researchers: Do they/we need a "Hippocratic Oath"? No common code per se

Physicians & non-physicians involved in medical research

Conflicts of interest between patients & research

Multiple interests at stake:

Individual vs. team; promotions, grants

Helping others vs. basic knowledge


Conflicts of interest: Boylan & Brown's case of Judge Goode

Duties vs. personal interest


Case presentation model: This is a demonstration of the use of the Hastings Center Model highlighing a case involving conflicts of interest, among other things.


Case defined: Lab supported by grants to study indicators for staging cancer & to establish model cell lines. New idea by MD/Co-PI for research to identify novel tumor antigens. Other players: Supervising MD/PI, lab manager, research techs, surgical staff, hospital director, patients. Materials needed: normal & cancerous tissue.


1. Key issues & dilemmas; ethical problems

Co-PI: conflict of interests: duty to patients vs. personal interest in research

PI: conflict of interests: management of funds, management of staff [including Co-PI] vs. friendship with Co-PI

Lab manager: GLP of projects, management under 2 bosses vs. supervising techs

Techs: follow conflicting orders vs. avoiding ethical violations

Surgical staff: potential witness to unethical surgery- duty to report vs. personal interest

Hospital director: confidentiality of ethics violation report vs. duty to physician community

General ethical problems: patient consent, patient confidentiality, surgical notes as legal documents, fiscal accountability


2. Background: Project design & protocols- Research Subject Protection Committee review required for any work involving human subjects, IACUC review required for any work involving animals; controls defined: matching type of tissue vs. matching individual's normal vs. malignant tissue; specific restrictions of grant funds [requiring committee review] vs. more general uses [exploratory projects]

Relevant facts: Co-PI's understanding of controls, specific directions by PI; no protocol review [violation of ethics]; samples of tissue collected- [violations], surgical nurse hands samples to tech; recorded surgical notes lacked reference to organ resection in non-CA patient- [violation]- How should they be assessed?

Other facts: PI unavailable for meeting with lab staff; lab manager married with children & owned a house; techs- single or married, no kids, all were renters

[In class discussion of the following steps.]

3. What types of experts and/or stakeholders need to be consulted?

4. What values are involved?

5. Solutions? How are the better ones chosen? Any consequences?

6. How should decision making process be organized?


What are the duties to future generations of humans; to other organisms; to the environment?

Removing "bad" genes; monoculture of plants; etc.

See Fig. 2.3: Value-Duty Relation

References:

1. Bruce Jennings, Kathleen Nolan, Courtney S. Campbell, Strac Donnelley, 1991. New Choices, New Responsibilities: Ethical Issues in the Life Sciences, Hastings Center, New York.

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 Updated 2/17/03 by thatcher@sonoma.edu