Hospital ethics committees and nurses' participation

The hospital ethics committee's mandates of patient care review, policy formation, and education make them central to nurses and healthcare delivery. In a study examining nurses' communication exchange frequency and perceived effectiveness as members of hospital ethics committees, nurses represented the largest proportion, were moderately active, and rated their participation effectiveness the highest: they are more involved in discussions regarding patients than policy formation and education. Nurse administrators can provide strategies and education for nurses that enhance nurses' participation in all three committee functions. Policies affect patient care; therefore, policy decisions, too, benefit from nurses' participation.     

Ethical review of multi-centre research: a survey of local research ethics committees in the south Thames region

We reported a 63-year-old woman with myotonic dystrophy (MD), who had frequent swallowing disturbances and died from suffocation asphyxia. Her esophagus on CT image 30 minutes after taking semi-solid meal showed dietary remnants in the middle portion of esophagus with entire esophageal dilatation. At autopsy, there was marked atrophy in the striated muscles in the upper part and smooth muscles in the lower part of the esophagus. The site of dietary stagnation on CT image was identical to the atrophic smooth muscle layer seen at autopsy. We speculate that one of the causes of esophageal motor dysfunctions is smooth muscle atrophy. The dietary stagnation in the esophagus may increase a risk of the asphyxia. Therefore we need to keep patients at the straight position during and after dietary ingestion to prevent respiratory problems.     

Are research ethics committees behaving unethically? Some suggestions for improving performance and accountability

The results of recent empirical investigations in research synthesis imply that research ethics committees are behaving unethically by endorsing new research which is unnecessary and by acquiescing in biased under-reporting of research which they have approved. The performance and accountability of research ethics committees would be improved if they required those proposing research to present systematic reviews of relevant previous research in support of their applications; to summarise the results of these reviews in the information prepared for potential participants; to register new controlled trials at inception; and to ensure that the results of these trials are made publicly available within a reasonable period of time after completion of data collection.     

The roles and functions of hospital-based ethics committees

Ethics committees ar becoming much more visible on the Canadian health care scene. They range from research-ethics committees that decide whether research projects are ethically sound to case-oriented committees that look at particular issues and give advice. Eike-Henner Kluge says that ethics committees are useful tools, but only when they are appropriately constituted and function in a professional manner. Otherwise, he warns, they become either useless or a liability.     

Exploring the relationship between ethics committees and the wound care clinician

Ethics Committees have gained increasing popularity since the mid-1970s. This is likely due to the recognized need to more openly discuss the legal and ethical issues of clinicians and their patients. Wound care clinicians play an important role in the interdisciplinary care of the patient. The typical framework of a hospital-based Ethics Committee is described, Ethics Committees as a resource to the wound care clinician is presented, and the role of the wound care clinician as a consultant to the Ethics Committee, from an interdisciplinary perspective, is illustrated.     

The behavior of nonpsychologists on research review committees.

The power to pass on the acceptability of psychological research is being given with increasing frequency to research review committees that usually include nonpsychologists (NPs). Thus, it is important for researchers to be able to anticipate the likely reactions of NPs to the content and procedures of their experiments. This article reviews research of factors affecting the acceptability of psychological research by NPs, and suggests further research (e.g., on the role of personality and situational variables) to help clarify the behavior of NPs on research review committees. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research on research ethics.

Comments that the research agenda outlined by B. Stanley et al (see record 1988-00068-001) is substantially incomplete, lacks citations of research to illustrate some of the significant issues, and is distorted by its concentration on the informed consent process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ethics of cardiac arrest research

In cardiac arrest research, prior informed consent is not available to resolve the conflict between the rights and well-being of subjects and the possible benefit to future patients. The right to autonomy is the fundamental right that is protected by the legal doctrine of informed consent. As a fundamental right, it cannot be balanced against other goods. Rather, it is a constraint, or trump, on the balancing of goods and can be overridden only for a narrow range of reasons: its recognition in a given case conflicts with another basic right, infringing the right will prevent great harm to others, and excluding a particular case from its scope will recognize and advance the right in the long run. Proxy consent, deferred consent, and presumed consent to cardiac arrest research are examined to determine if they qualify as justified infringements of the right to autonomy. The conclusion is that only presumed consent can be used, provided that the researcher can honestly say that outside of the randomized clinical trial of two or more treatments, a physician would have no basis for choosing one over the others.     

Contributions of empirical research to medical ethics

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine.     

Medical research ethics 50 years after Nuremberg

50 years ago, in Nuremberg, 23 German doctors were accused of crimes against humanity. The anniversary is a solemn reminder of the dark origins of medical research ethics. Many researchers today believe that the medical experiments carried out under Hitler "vaccinated" postwar researchers against abuse. A review of the practices of postwar research shows that the "vaccination" had limited effect and that there is no reason to believe that the events which took place under Hitler were unique and will never happen again. After the war various measures were introduced to protect research subjects: informed consent, self regulation and independent research ethics committees. The measures have undoubtedly limited the abuse of subjects substantially. Nevertheless, in the Armed Forces, where abuse has been most rampant after the war, informed consent is not always practised and independent review is seldom carried out. With the support of grant institutions, journals and industry the protection of research subjects can be improved. It is recommended that medical faculties arrange an annual commemoration of the victims of medical research in order to raise consciousness and awareness among teachers and students.     

Applications submitted to regional research committees in 1976 and their outcome

In 1976 regional research committees in England and their equivalent in the Welsh Office judged 608 proposals for funding under the locally organised research scheme. Of these, 521 were new proposals and 87 were resubmissions. Medically and dentally qualified applicants made 451 (87%) of the new proposals; nearly two-thirds came from teaching areas and 21% from staff of academic departments. Two hundred and ninety new proposals were approved, 154 rejected, and 77 were referred back for modification. Approval was commoner for applications from teaching areas, from medical staff, and for the less expensive projects. Some regional committees did not support research into the organisation of health services. Under a quarter of the resubmitted projects were rejected. The scheme is not yet used by a wide range of health-care professions. Medical staff in teaching areas still use it most. In some regions prospective researchers, especially those without previous experience, need a comprehensive and easily identifiable counselling service, so that the fund may be exploited in the way originally intended and the number of unsuccessful proposals reduced.     

Analysis of a survey of 36 French research committees on intracytoplasmic sperm injection

BACKGROUND: In France, when a new medical technology is to be applied experimentally to human beings, it must adhere to the principles stipulated by the Huriet-Sérusclat law on biomedical research. This law requires that the validation of a protocol applicable to human beings, with its corollary protection and information dimensions, is first submitted to a research committee, known as a Consultative Committee Protecting Persons in Biomedical Research (CCPPRB). We aimed to survey the competence of these committees in biotechnology, and whether or not intracytoplasmic sperm injection (ICSI) had been considered by the committees as being an innovative treatment. METHODS: We presented each of France's 48 CCPPRBs with a questionnaire to assess the choices and criteria for making decisions that arose at the time ICSI was implemented in the different centres in each region. FINDINGS: 36 committees took part. We found that ICSI had been largely introduced in settings outside the scope of the CCPPRBs and of the framework fixed by the law on biomedical research. Only three centres for medically assisted reproduction had submitted applications to a CCPPRB, although ICSI has been implemented in over 20 centres. 21 (58%) committees were of the opinion that the implementation of ICSI could have come under their supervision. 24 (67%) committees believed that, independently of their own involvement, evaluation procedures for ICSI should have been specified before centres decided to introduce it. INTERPRETATION: We observed important differences in the way CCPPRBs handled ICSI as being within or outside the medical research field. The status of the research committees is legally and identically defined. However, committees did not agree on the definition of the limits of their action, and, therefore, their handling of the same issue differed. An inquiry is needed to define how, now that ICSI is done in many centres, it should adhere to principles of evaluation and safety already in existence for other medical technologies.