Order ID | 53563633773 |
Type | Essay |
Writer Level | Masters |
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Ethical Philosophies in Healthcare Course Paper
Ethical, Philosophies, Healthcare, Course, Paper
Ethical principles form the foundations for decision making within the many stages of the research process. This article will consider the seven ethical principles that are most frequently highlighted in the literature:
Beneficence.
Non-maleficence.
Fidelity.
Justice.
Veracity.
Confidentiality.
Respect for autonomy.
Although these principles will be considered individually, they are not mutually exclusive. This arti-cle will demonstrate that these principles are closely linked, and that a simple question or a complex dilemma may involve more than one ethical principle.
Beneficence is the requirement to benefit the patient. It is the underlying principle in all medicine, health care and research (Faden and Beauchamp 1986). Physicians are primarily guided by the Hippocratic Oath, which states: ‘I will use the treatment to help the sick according to my ability and judgement, but never with a view to injury and wrongdoing.’
Nurses must adhere to the Code of Professional Conduct (UKCC 1992), which states that the nurse must:
‘…act always in such a manner as to promote and safeguard the interests and well-being of patients and clients’ (UKCC 1992).
Both codes emphasise the necessity to benefit the patient and not to do harm. The aim of benefiting the patient applies as much to research activities as it does to clinical care. Elements The principle of beneficence can be further divided into four distinct and indepen-dent elements (Box 1) (Faden and Beauchamp
1986). Beneficence is characterised as an active state as opposed to non-maleficence which is a passive state. This suggests that non-maleficence is an extension of beneficence. However, it is necessary to separate these two ethical principles because they may conflict (Faden and Beauchamp 1986).
Beneficence obliges the researcher to weigh or balance the potential benefits against the potential risks (Faden and Beauchamp 1986, Garity 1995). The potential to cause harm is unavoidable – when anyone tries to help some- one, he or she risks causing harm to that person (Gillon 1994).
Researchers should ensure that projects demonstrate the potential for net benefit over harm. The potential benefits should always outweigh the risks and the research participant should always be considered more important than the research protocol, even if this means invalidating data (Tarling and Crofts 1998).
Research should benefit the individual and society in general (Parahoo 1997), but the benefits to society should not take precedence over the safety of the patient. The beneficence of any action is extremely personal and may differ between individuals (Gillon 1985a). This high- lights the link between the principles of beneficence and autonomy.
Beneficence is the most important principle for nurses involved in clinical research. It is unethical to involve patients and research participants in any research if no benefit is expected either to the patient or to society. The researcher should always place more emphasis on the safety of the research participant than any other factor.
Beneficence
Introduction
Ethical principles in healthcare research
Ethical principles underpin decision making in the research process. This article considers
the seven ethical principles that are most frequently highlighted in the literature. Although
the principles will be considered individually, they are not mutually exclusive, and the
article demonstrates that they are closely linked.
Gelling L (1999) Ethical principles in healthcare research. Nursing Standard. 13, 36, 39-42. Date of acceptance: January 21 1999.
These key words are based on subject headings from the British Nursing Index. This article has been subject to double-blind review.
Ethics
Research methods
key words
Leslie Gelling BSc (Hons), RGN, is Research Nurse, Academic Department of Neurosurgery, University of Cambridge.
One ought not to inflict evil or harm. One ought to prevent evil or harm. One ought to remove evil or harm. One ought to promote good
Box 1. The elements of beneficence
40 nursing standard may 26/vol13/no36/1999
Non-maleficence assumes that no harm should come to the patient or research participant as a result of taking part in a study (Faden and Beauchamp 1986, Garity 1995). This principle is closely linked to beneficence, but it is difficult to estimate or monitor the harm to which research participants may be exposed.
This harm may be physical, emotional, social or economic (Burns and Grove 1995). A physical harm may be easily identified and, therefore, avoided or minimised. Emotional, social and economic factors may be less obvious and the participant may be harmed without the researcher being aware.
All research studies have the potential to cause harm to research participants (Tarling and Crofts 1998) and there are five categories into which studies can be placed according to the level of harm or discomfort to which they may be subjected (Reynolds 1972): No anticipated effects. Temporary discomfort.
Unusual levels of temporary discomfort. Risk of permanent damage. Certainty of permanent damage. No anticipated effects These studies usually do not involve any contact with the research participant and frequently entail the review of medical notes or documentation. However, researchers should be aware that they are invading the per- son’s privacy.
It is important to consider the need to acquire informed consent even though there may be no further contact with the participant. Temporary discomfort in these studies, the dis- comfort to the participant is temporary and is similar to that which he or she would encounter in his or her daily life. It ceases when their involvement in the study ceases. These projects usually involve questionnaires and interviews that involve minimal risk.
However, risks do exist and may include fatigue, headaches, muscle tension, anxiety, embarrassment and time commitment. The researcher should be aware that these risks may occur and have strategies for managing them. Unusual levels of temporary discomfort the research participant may experience discomfort during and after completion of the study.
These studies may include interviews about psychologically stressful experiences that may continue to distress participants for some time after their contact with the researcher has ended. The researcher should be aware of the potential risks and be prepared, if necessary and appropriate, to refer participants to a trained counsellor.
Risk of permanent damage This research is most common in biomedical research involving drug studies, where some of the adverse effects of the active substance may be unknown. Such sub- stances undergo an extensive period of research, sometimes lasting many years, before they are administered to humans.
However, some uncertainty remains, so the researcher should have strategies in place to manage adverse events. Certainty of permanent damage This type of research is highly questionable regardless of the
benefits that may be gained. The experiments per- formed by Nazi doctors would fall into this cate- gory. These studies violate the fifth principle of the Nuremberg Code, the Hippocratic Oath and the Code of Professional Conduct. No studies that fall into this category should be allowed to proceed.
The ethical principle of non-maleficence should go a long way to protecting research participants from harm as a result of research. Equipoise should exist between the potential risks and benefits. The risks should never outweigh the bene- fits and the researcher should be aware that there are potential risks with all research.
Fidelity is the research principle concerned with the building of trust between the researcher and the participant (Parahoo 1997). The research participant will entrust him- or herself to the researcher, who subsequently has an obligation to safeguard the participants and their welfare in the research situation (Garity 1995).
It is important to gain the participant’s trust by being open and honest (Alderson 1995). There are some risks associated with all research and there may be some risks that are still unknown (Tarling and Crofts 1998). To build a trusting relationship, the researcher must make sure that the research participant knows about the risks. The provision of this information should occur during the process of gaining informed consent.
Hospital patients will often agree to anything a nurse or medical researcher suggests. A potential participant may view an invitation to take part as a recommendation rather than a request (Hewlett 1996). The trust that research participants place in researchers obliges them to be faithful to their commitment for protection.
This research principle requires the researcher to be fair to participants (Parahoo 1997). The needs of the research participants should always come before the objectives of the study. The main problem with this ethical principle is the selection of populations (Garity 1995).
Vulnerable groups such as older people, those who are mentally ill, the military or prisoners, should not be used merely for their convenience. Questions may also be raised if there is a financial reward for researchers, or their organisation, to undertake the research.
If any researcher is to use a vulnerable population, he or she should justify this decision. This is usually done by applying for ethical approval. All potential research participants in the healthcare setting are vulnerable by the nature of their com- promised health status.
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