EPY - Ethical Issues in Epidemiology Lesson

Ethical Issues in Epidemiology

According to the Miller-Keane Encycolopedia and Dictionary of Medicine, Nursing, and Allied Health, Epidemiology is definied as "the science concerned with the study of the factors determining and influencing the frequency and distribution of disease, injury, and other health-related events and their causes in a defined human population for the purpose of establishing programs to prevent and control their development and spread." Therefore, many different studies and trials are performed on a given population in order to see the positive affects and the negative affects of certain diseases. While most of these studies are done in order to aid the human race, many people call into question the ethical issues connected to studies, trials, and surveys.

Ethical Issues

There are four basic principles of medical ethics. Each addresses a value that arises in interactions between providers and patients. The principles address the issue of fairness, honesty, and respect for fellow human beings.

  • Autonomy People have the right to control what happens to their bodies. This principle simply means that an informed, competent adult patient can refuse or accept treatments, drugs, and surgeries according to their wishes. People have the right to control what happens to their bodies because they are free and rational. And these decisions must be respected by everyone, even if those decisions aren't in the best interest of the patient.

  • Beneficence All healthcare providers must strive to improve their patient's health, to do the most good for the patient in every situation. But what is good for one patient may not be good for another, so each situation should be considered individually. And other values that might conflict with beneficence may need to be considered.

  • Nonmaleficence ''First, do no harm'' is the bedrock of medical ethics. In every situation, healthcare providers should avoid causing harm to their patients. You should also be aware of the doctrine of double effect, where a treatment intended for good unintentionally causes harm. This doctrine helps you make difficult decisions about whether actions with double effects can be undertaken.

  • Justice The fourth principle demands that you should try to be as fair as possible when offering treatments to patients and allocating scarce medical resources. You should be able to justify your actions in every situation.

Below you will learn about a well known study called The Tuskegee Study. However, before we go into the details of that study, let's learn about the disease covered in that study: Syphilis.

Syphilis

EPY_Syphilis.pngSyphilis is passed from person-to-person through direct contact with a syphilis sore (called a chancre). Chancres mainly occur on the external genitals, vagina, anus, or rectum, but may also occur on the lips and in the mouth. Transmission of syphilis occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it on to their babies.
The first symptoms of syphilis can appear from 10-90 days (average 21 days). The first stage is marked by the appearance of a chancre that is usually firm, round, small, and painless. The chancre lasts 1-5 weeks and heals on its own. The second stage of syphilis begins when one or more areas of the skin develops a non-itching rash. Rashes can appear as rough, "copper penny" spots on the palms of the hands and bottom of the feet; a prickly heat rash, small blotches or scales all over the body; a bad case of old acne; moist warts in the groin area; white patches in the mouth; sunken dark circles the size of a nickel or dime; or as pus-filled eruptions like chicken pox. Rashes can last 2-6 weeks and, like the chancre, heal on their own. During the first and second stages of syphilis, an infected person can easily pass the disease to their sex partners.
The latent (hidden) stage of syphilis begins when the secondary symptoms disappear. If the infected person has not received treatment, he/she still has syphilis even though there are no symptoms. Syphilis remains in the body and begins to damage the internal organs including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.
Bicillin, a type of penicillin (G benzathine), will cure a person who has had syphilis for <1 year. More doses are needed to cure someone who has had it longer. A baby born with the disease needs daily penicillin treatment for 10 days. There are no home remedies or over-the-counter drugs that cure syphilis. Washing the genitals, urinating, or douching after sex does not prevent syphilis.

The Tuskegee Study

You may have heard of some national studies or some smaller scale studies such as surveys in your own community. You may also have heard of well-publicized ones like the experiments described in the Nuremberg trials or Tuskegee.

The U.S. Public Health Service Syphilis Study at Tuskegee was carried out in Macon County, Alabama, from 1932 to 1972. The United States Public Health Service, in trying to learn more about syphilis and justify treatment programs for blacks, withheld adequate treatment from a group of poor black men who had the disease, causing needless pain and suffering for the men and their loved ones. In the wake of the U.S. Public Health Service Syphilis Study at Tuskegee and other studies, the federal government took a closer look at research involving human subjects and made changes to prevent the moral breaches that occurred in Tuskegee from happening again. Read the details of The Tuskegee Study by visiting this link:  US Public Health Service Syphilis Study at Tuskegee Links to an external site. or google Tuskegee Syphilis Study.

Institutional Review Board

An institutional review board (IRB), also known as an independent ethics committee or ethical review board, is a committee that has been formally designated to approve, monitor, and review biomedical and behavioral research involving humans. They often conduct some form of risk-benefit analysis in an attempt to determine whether or not research should be done. The number one priority of IRBs is to protect human subjects from physical or psychological harm. In the United States, the Food and Drug Administration (FDA) and Department of Health and Human Services regulations have empowered IRBs to approve, require modifications in planned research prior to approval, or disapprove research. IRBs are responsible for critical oversight functions for research conducted on human subjects that are 'scientific', 'ethical', and 'regulatory'. IRBs were developed in direct response to research abuses earlier in the 20th century.

The purpose of an IRB review is to assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in a research study. IRBs attempt to ensure protection of subjects by reviewing research protocols and related materials. IRB protocol review assesses the ethics of the research and its methods, promotes fully informed and voluntary participation by prospective subjects capable of making such choices and seeks to maximize the safety of subjects.

Source: www.wikipedia.com

 

[CC BY 4.0] UNLESS OTHERWISE NOTED | IMAGES: LICENSED AND USED ACCORDING TO TERMS OF SUBSCRIPTION