BMC Medical Ethics: Highlights of 2018

BMC Medical Ethics in 2018 published many thought-provoking manuscripts, below are 5 of the highlights selected by the Editorial Team.

#FakeNews in Medical Research

Recently popularized by a certain populist political figure the phrase ‘Fake News’ has entered the global public lexicon and is routinely weaponized in the arenas of internet debate.

Hoffman presents a debate examining how, for controversial topics, some researchers can be biased towards publishing only positive conclusions whilst others only publish negative conclusions, even when these conclusions use the same data.

The controversial topic for this debate is the efficacy of mammography screening in the detection of breast cancer.   The debate identified 8 manuscripts which studied mammography accuracy and then, through consultation with experts in polarized research, ranked the attitudes of the corresponding authors towards screening.

It was found that the efficacy of the screening reported in the manuscripts correlated with the ranked attitudes of the corresponding authors, suggesting that personal views were influencing the scientific record.

Advice on how Editors, Reviewers and Researchers can handle conflicts of interest are found within the article’s conclusion.  For instance Editors should take into account the personal biases of researchers when inviting them for peer-review.

And, with no conflicts of interest whatsoever to declare, it is the position of Liam and Lingling that this is probably the best article on how personal views can influence research published ever.

Difficulties in administering Euthanasia to patients with Intellectual disabilities

Euthanasia and physician-assisted suicide (EAS) has been legally possible in the Netherlands since 2001 provided the following criteria are met

  1. The request is voluntary;
  2. The patient’s suffering is unbearable, with no prospect for improvement;
  3. The patient is fully informed of the prospect of euthanasia;
  4. There is no, reasonable, alternative treatment available
  5. At least one other physician, independent of the one assisting, provides an opinion concurring with the decision

Discussions on EAS legislation for vulnerable people, especially for those with intellectual disability or autism spectrum disorder, are sparse.

The authors analyzed 9 case summaries, published between 2012-2016, concerning either intellectual disability or autism and EAS. The authors conclude that the above criteria are not easily applied to people with intellectual disabilities or autism.

A specialist intellectual disability physician is suggested to be involved in all cases where someone with an intellectual disability requests EAS, and that all physicians involved in capacity assessments of patients with intellectual disabilities or autism spectrum disorder (including those offering a second opinion) must have enhanced training in this area.

Globally, sufficient measures to protect vulnerable patients should be carefully considered while planning to introduce or adapt EAS legislation.

Is it ethical to include patients in research?

Traditionally, research is conducted on patients, however increasingly research is being performed with patients collaborating with the investigators.  This phenomenon is termed Patient Engaged Research (PER). At present the ethical issues involved with PER have been largely unexplored.

The authors conducted a three-round Delphi survey with a panel of early-career researchers (ECRs) from various backgrounds, ranging from general practitioners to postgraduate students to identify ethical issues.

Experienced ECRs were more worried about the applied aspects of PER, such as patient remuneration, recognition of patient contributions and confidentiality. In contrast, junior researchers were concerned with theoretical issues, such as power dynamics between researchers and patients and the exploitation of vulnerable persons. However, both junior and senior ECRs felt inadequately prepared to address the ethical issues despite their overall readiness to conduct PER.

Without the establishment of clear ethical standards for PER, the authors fear that the credibility of PER will suffer and its adoption of as a research practice may be inhibited.

Conscientious objection to abortion by midwives and nurses

Abortion remains a morally contentious issue, and some midwives and nurses might decline to recommend it on the grounds that it conflicts with their personally held religious or ethical beliefs. Fleming et al conducted a systematic review to identify the views of midwives and nurses on the right to object to the provision of an abortion.

Nurses’ and midwives’ views were classified as ‘Moral’, ‘Legal’, ‘Practical or ‘Religious’.  Interestingly all of the manuscripts included in the review, despite being focused on the views of nurses and midwives were written exclusively by physicians, philosophers, legal scholars and lawyers.

81 reasons for midwives and nurses to consciously object to abortion provision were identified.  The most common reason for objection was that one’s conscience is an ‘inner voice that [needs] to be listened to’ and that ‘Religious law should be followed’.

Reasons against conscientious objection were also highlighted with the most popular being that health care providers must separate ‘moral belief from [their] professional life’ and that women have a right to access abortions.

A plurality of reasons both for and against the ability of midwives and nurses to refuse to recommend abortions was unearthed but also, and perhaps more importantly, was the dearth of written work directly from these very professions on the topic.

First things first, the ethics of prioritizing global health research

Time is finite and it is rarely possible to clear one’s inbox let alone address the myriad of health issues which ravage the globe.  As a result the prioritization of which research questions should be tackled first is of upmost importance to policy makers, researchers and ethicists.

The act of prioritizing, itself, is an ethical consideration; for instance should the world’s governments, charities and philanthropists focus more on infectious disease research than on, say, curtailing obesity?

Pratt et al, report on the outcomes of an International Workshop entitled ‘Ethics of Global Health Research Priority’ held in Oxford.  Global health and ethics experts gathered to discuss the ethical considerations of prioritizing global health research.

The attendees’ reflections have been summarized as 8 research questions such as; “which groups should initiate and lead global health research priority settings?” and “what is the right process for making decisions at this wide world level?”

This report serves as a guide and as a source of impetus for ethicists, researchers and policymakers to develop ethically sound and robust approaches to setting priorities

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