Ethical Attitudes of Nurse, Physician, and Unaffiliated Members of Institutional Review Boards

PURPOSE: To evaluate the recommendation for adding unaffiliated members to institutional review boards (IRB) by comparing the attitudes and influence of IRB members of different backgrounds, primarily nurses, physicians, and unaffiliated members. DESIGN: Survey. METHOD: A closed-ended self-administered questionnaire concerning ethical issues in human subjects research was completed by 284 IRB members in a nonprobability sample of 27 IRBs in 12 U.S. states. The attitudes and influence of IRB members with different backgrounds were compared. FINDINGS: Nurses rated most of the issues as more important than did all other members; physicians rated most of the issues as less important than did all other members; and unaffiliated IRB members rated the issues similar to the whole. Nurses and unaffiliated members were ranked the least influential IRB members, and IRB chairs and physicians were ranked the most influential. CONCLUSIONS: The responses of the IRB members in this study indicate that adding more unaffiliated members to IRBs is unlikely to increase IRB concerns with ethical issues. Adding more nurse members to IRBs might increase IRB concerns with ethical issues if the level of influence of the nurses is increased.     

Socially optimal dosing for scarce vaccines: Ethical analysis through the principlism framework

Rationale, Aims, and Objectives

Under conditions of vaccine scarcity, the socially optimal dosing (SOD) strategy administers a lower dose of vaccine to a larger number of people than the individually optimal dosing (IOD) strategy, which administers a higher dose of vaccine to a smaller number of people. In the context of vaccines that generate diminishing returns of effectiveness with each additional dose beyond the first, SOD therefore generates a greater total amount of vaccine-induced protection than IOD and, as such, constitutes the socially optimal strategy. While the clinical and public health arguments in favour of SOD have previously been outlined, this article conducts an ethical analysis of SOD for scarce vaccines through the ethical framework of principlism.

Methods

SOD is examined with regard to each principle within the principlism framework—nonmaleficence, beneficence, autonomy, and justice.

Results

SOD is found to satisfy each of the ethical requirements under examination. Regarding nonmaleficence, SOD induces less iatrogenic harm than IOD since the dose of vaccine administered to each individual is lower in the former than the latter. Furthermore, both the good and bad effects of SOD are foreseen while only the good effects are intended, meaning this strategy simultaneously satisfies the doctrine of double effect. Regarding autonomy, SOD makes vaccine-induced protection available to a greater number of individuals who wish to receive it, thereby respecting their capacity for self-determination and to make independent decisions. Regarding beneficence, SOD renders the good—namely the protection of health—more widely available to the individuals that constitute the population in question. Finally, SOD promotes theories of justice that treat individuals equally and is unlikely to reduce the effectiveness of other distribution policies that allocate scarce vaccines in a just manner.

Conclusion

In conditions of vaccine scarcity, SOD favourably satisfies the ethical framework of principlism.     

Mental health quality improvement: What about ethics?

Nurses are increasingly developing and coordinating quality improvement projects under the auspices of state, area health service and organization policies, however, ethical frameworks are commonly absent. This study aims to define key terms, provide an overview of current policy in relation to ethics and outline some procedures and processes for mental health nurses involved in such projects. The use of appropriate ethical frameworks has the potential to foster participation and safeguard participants by providing a greater assurance of integrity and confidentiality regarding quality improvement data collection, utilization and dissemination.     

Navigating complex trade-offs in public health interventions

Public health, just as any policy-related field, faces the evergreen problem of turning knowledge into action. Among other problems, there is a clash between the inherent complexity of public health problems and the inevitable push, by decision-makers and the public, to simplify them. The Covid-19 pandemic has shown the insufficiencies of our current epistemological, methodological and normative apparatus to handle such crises in a timely manner. Despite this, several authors have been arguing for the importance of engaging global crises such as Covid-19 in ways that do not oversimplify key dimensions of the issues involved. In this paper, we contribute to this emerging scholarship. Building on existing work in the field of environmental problem-solving, we propose an integrative approach to navigating complex trade-offs in public health interventions. Briefly put, we propose that decision making should be informed by an analysis of any given problem from four distinct, but interrelated, lenses: (i) values and valuation, (ii) process and governance, (iii) power and inequalities and (iv) scientific evidence, methods and concepts. This normative framework, we argue, can help with spelling out the complexity of public health problems and with spelling out the rationale behind public health decision making to non-specialists and the general public. We illustrate our approach using the controversy over wearing face masks in the Covid-19 pandemic.     

Philosophical and ethical perspectives on cardiovascular disease risk in low-wage workers

ABSTRACT One of the overriding goals of Healthy People 2010 is to reduce the health disparities observed among Americans. Because workers in small businesses tend to have little or no access to health screening or preventive health education programs, they may be unaware of their unique risk factors and are thus more at risk of cardiovascular disease (CVD). Furthermore, occupational health nurses are more likely to be available in health programs to employees in large rather than small businesses. The purpose of this paper is to illustrate how nursing values and philosophy might influence public health nurses' thinking about nursing science and ethical issues relating to the risk of CVD among low‐wage workers. The following questions will guide the exploration of health disparities among low‐wage workers: (a) What are the health disparities observed among low‐wage workers with CVD risk? (b) What are the philosophical and ethical perspectives on the issues presented? (c) Based on these findings, how should limited resources be allocated? and (d) How does this affect nursing? These approaches will provide the foundation for developing a culturally sensitive ethical and philosophical perspective to prevent CVD and promote cardiovascular health among low‐wage workers.     

Legal and ethical aspects of seclusion: an Australian perspective

The debate about the appropriateness of seclusion as a nursing practice in inpatient settings in the 21st century continues, with powerful and often emotive arguments from those who view it as an anachronistic and punitive form of ward management, and from others who see it as a useful emergency measure to protect individuals from imminent harm. This is the first paper, however, to focus on legal and ethical issues in relation to the use of seclusion, with policies and practices in Australian psychiatric institutions viewed within the context of worldwide trends. The interplay of ethical principles and international mental health law has encouraged a move towards the provision of care and treatment of the disturbed psychiatric patient within the least restrictive environment, supposedly reducing the potential for the inappropriate use of control mechanisms. Nevertheless, current legislation can be seen to preserve the status quo because it legitimizes seclusion as an acceptable nursing practice, albeit within given parameters, thereby defusing the imperative to promote the reduction and abolition of psychiatric control mechanisms and seek new possibilities in mental health care.     

Piloting a Nationally Disseminated,Interactive Human Subjects Protection Program for Community Partners: Design,Content, and Evaluation

Funders, institutions, and research organizations are increasingly recognizing the need for human subjects protections training programs for those engaged in academic research. Current programs tend to be online and directed toward an audience of academic researchers. Research teams now include many nonacademic members, such as community partners, who are less likely to respond to either the method or the content of current online trainings. A team at the CTSA‐supported Michigan Institute for Clinical and Health Research at the University of Michigan developed a pilot human subjects protection training program for community partners that is both locally implemented and adaptable to local contexts, yet nationally consistent and deliverable from a central administrative source. Here, the developers and the analysts of this program discuss its development, its content, and the results of its evaluation.     

Ethics Seminars: Health Care Proxies and Suicidal Patients

Advance directives, health care proxies, and living wills are forms of advance planning that permit patients to make decisions regarding their health care and are used when the patient becomes incapacitated. The ethics of allowing these forms of advance planning are questioned when the patient has attempted suicide. The authors present an ethical analysis of a case of an elder patient who overdosed on sustained-release diltiazem and had a health care proxy who wanted all treatments stopped.     

Community treatment orders: the ethical balancing act in community mental health

Community treatment orders (CTOs) are legal mechanisms by which an individual with a mental illness and a history of non-compliance and potential for violence can be mandated (against their will) to undergo psychiatric treatment in an outpatient setting. Although CTOs are increasingly being adopted by governments as a means of protecting both mentally ill persons and society itself, their use continues to stimulate considerable debate. While there is some evidence of their potential benefits in promoting treatment compliance and reducing hospital stays, there is concern that they infringe on the mental health client's human rights and freedoms. Consideration of the ethical and practical implications of the use of CTOs must continue. In this paper, some of the most pressing issues are identified and discussed.     

Health promotion and health education: what role should the nurse adopt in practice?

Health promotion and health education: what role should the nurse adopt in practice? ¶ Health promotion is widely accepted as part of the role of the nurse, midwife and health visitor. Theoretical definitions of health promotion and health education are presented. The author suggests that a variety of different approaches to health promotion can be adopted by nurses in practice, including education, persuasion, manipulation and attempts to promote an environment where healthy decisions about lifestyle can be made. Each strategy is examined and the advantages and the ethical limitations are explored. It is suggested that nurses may theoretically accept the notion of being a health promoter, but that in the reality of practice, their role may be primarily that of the health educator. The importance of recognizing that there are a variety of determinants of health, including social and environmental factors, as well as individual lifestyle, is emphasized throughout the paper.