Classmate Response -Mary-(2): Topic 6 DQ 1 -summarize a historical ethical dilemma in public health

QUESTION-After reading various topic resources and textbook chapters, summarize a historical ethical dilemma in public health. How may this relate to a current ethical dilemma? Were there any lessons learned from the historical event that can help public health nurses address the current ethical dilemma?

Mary -Classmate Response Topic 6 DQ 1

Ethics have been needed in the medical field since the very beginning, however, for many reasons they have not always been a part of practice throughout history. Nursing ethics are founded upon the four basic principles in medical ethics which are autonomy, nonmaleficence, beneficence and justice (Dale, 2016). It seems that many of the ethical dilemmas have come about through unethical research practices which stem from not following the 4 core principles listed.

One example of this is the Willowbrook study in which researchers attempted to find a valid vaccine and discover the pathophysiology of the Hepatitis virus by infecting children living in a home for intellectually disabled individuals with the virus (Kumar, 2016). This remains a dilemma today because the school had asked the researchers to investigate outbreaks of the illness in the school and the idea was that the healthy children would likely have gotten the illness anyway, the researchers fully informed the parents of the risks and benefits of the study and provided what they thought was better treatment than the children infected before they began their study had received (Kumar, 2016). Others argued that parents were incentivized to allow their children to be part of these experiments and that no medical professional should do anything to weaken the mental and physical health of a patient except for therapeutic and prophylactic reasons (Kumar, 2016). Many of the critics of this experiment at the time voiced the necessity to protect the patient and that the medical professional’s job was to prevent and treat the current cases rather than to create and study new cases, especially in such a vulnerable population (Kumar, 2016).

As we look back on this example in which medical ethics were breached in the interest of researching a public health crisis, we can learn from past mistakes. The current COVID-19 crisis has created much medical research need and because of past issues, there are now laws, ethical committees and advocates that prevent unethical research being done on vulnerable populations. For example the WMA produced the Helsinki Declaration which states that conducting research on a vulnerable population can only be justified when the research is in response to specific health needs and priorities of the particular group, if the research cannot be conducted on a non-vulnerable population and if the group will benefit from the knowledge, interventions and practices that result from the study (Hlongwa, 2016).

Dale, O. (2016). Ethical issues and stakeholders matter. Addiction, 111(4), 587–589. https://doi-org.lopes.idm.oclc.org/10.1111/add.13267

Hlongwa P. (2016). Current ethical issues in HIV/AIDS research and HIV/AIDS care. Oral diseases, 22 Suppl 1, 61–65. https://doi.org/10.1111/odi.12391

Kumar, A., (2016). The duality of medicine: The Willlowbrook state school experiments. Retrieved from https://mdrnyu.org/spring-2016-the-duality-of-medicine-the-willowbrook-state-school-experiments/

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Solution

Classmate Response -Mary-(2)

I agree with you that past events where healthcare researchers have targeted vulnerable groups and even actively caused harm to research participants during the process of research are unethical. Incidents in the past, such as the Willowbrook study where researchers who were developing a vaccine for hepatitis virus actively infected children living in a home for the intellectually disabled with the virus, indicate a significant disregard for bioethical principles in the healthcare industry in the past (Yip et al., 2016). The strong safeguards related to the principles such as autonomy, beneficence, justice, and nonmaleficence in the healthcare industry in the present were therefore enacted because of historical unethical incidents. In contemporary times, patients are more protected from exploitation by different practitioners in the healthcare industry through bioethical principles (Yip et al., 2016). In the present times, healthcare practitioners have to present their research proposals to institutional review boards who examine the viability and determine that the research will not bring any harm to the target participants before approving such research. The thorough review processes and guidelines related to research in the field of healthcare have therefore been enacted to prevent the exploitation and harming of vulnerable populations by unscrupulous researchers. In the modern-day, there are therefore fewer incidences of unethical research practices due to the strict enforcement of ethical guidelines in the conducting of research. This is evident in the recent Covid- 19 pandemic, where only those who volunteered were involved in the research to develop vaccines.

References

Yip, C., Han, N. R., & Sng, B. L. (2016). Legal and ethical issues in research. Indian journal of anaesthesia, 60(9), 684–688. https://doi.org/10.4103/0019-5049.190627