Profound hypotension: ethical considerations

The use of profound induced hypotension to provide better operating conditions for surgery is long established. However, it is a controversial technique and it may be argued that it is inappropriate in modern anaesthetic practice. A currently used technique is reviewed against the benchmark of a lawsuit concerning profound hypotension.     

Longitudinal studies: objectives and ethical considerations

Studies discussed in this issue have in common that subjects are followed-up, the majority of studies with data collection on at least two occasions. However the need for follow-up in terms of the study hypotheses should be assessed carefully, because such studies are costly and more difficult to carry-out and analyse than cross-sectional studies. Studies are classified according to the nature of the explanatory and outcome variables, whether fixed for each subject, a transitional age, or a changing measurement or characteristic. The information that can be obtained is discussed for each combination of explanatory and outcome variables. Time trends are also considered. The different requirements of reference ranges are included, and ethical considerations particular to follow-up studies are briefly described.     

Mental health issues: ethical considerations

Employer-initiated psychiatric evaluations raise a number of ethical issues particular to mental health in the workplace. This article addresses the ethical concerns and potential legal implications of psychiatrist and employee role ambiguity (e.g., "mutual deception"); describes the elements common to psychiatric examinations in this setting; offers one way to provide information and documentation of a confidentiality waiver; reviews some differences between psychiatric and general medical IME evaluations; discusses interview and report record "ownership"; reviews dangerousness assessment strengths and limitations; and addresses treatment and restoration to fitness issues.     

Demographic and health surveillance: longitudinal ethical considerations

Longitudinal data gathered from health surveillance, when combined with detailed demographic information, can provide invaluable insight into disease outcomes. Many such surveillance sites exist in the developing world, particularly in Asia and sub-Saharan Africa, and focus on diseases such as HIV/AIDS, cholera, malaria and tuberculosis. The indistinct positions of such surveillance systems, often inhabiting an area between research, treatment and population health monitoring, means that the necessity of and responsibility for ethical oversight is unclear. This regulatory vacuum is further compounded by a lack of attention to longitudinal surveillance systems in ethics literature. In this paper, we explore some key ethical questions that arise during demographic and health surveillance in relation to ethical principles of beneficence, respect for persons and justice: health-care provision, informed consent and study sustainability.     

Disease gene identification: ethical considerations.

How can we offer genetic testing and screening with adequate protection? Who will have access to the results? How do we balance a person's desire to know with the pain that knowledge may bring? We can examine these issues in the light of our experience with two fatal autosomal diseases: cystic fibrosis, in which the gene is known, and Huntington's disease, in which it is not.     

Immunity certification for COVID-19: ethical considerations

Restrictive measures imposed because of the coronavirus disease 2019 (COVID-19) pandemic have resulted in severe social, economic and health effects. Some countries have considered the use of immunity certification as a strategy to relax these measures for people who have recovered from the infection by issuing these individuals a document, commonly called an immunity passport. This document certifies them as having protective immunity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes COVID-19. The World Health Organization has advised against the implementation of immunity certification at present because of uncertainty about whether long-term immunity truly exists for those who have recovered from COVID-19 and concerns over the reliability of the proposed serological test method for determining immunity. Immunity certification can only be considered if scientific thresholds for assuring immunity are met, whether based on antibodies or other criteria. However, even if immunity certification became well supported by science, it has many ethical issues in terms of different restrictions on individual liberties and its implementation process. We examine the main considerations for the ethical acceptability of immunity certification to exempt individuals from restrictive measures during the COVID-19 pandemic. As well as needing to meet robust scientific criteria, the ethical acceptability of immunity certification depends on its uses and policy objectives and the measures in place to reduce potential harms, and prevent disproportionate burdens on non-certified individuals and violation of individual liberties and rights.     

Participatory action research: considerations for ethical review

This paper addresses the distinctive nature of participatory action research (PAR) in relation to ethical review requirements. As a framework for conducting research and reducing health disparities, PAR is gaining increased attention in community and public health research. As a result, PAR researchers and members of Research Ethics Boards could benefit from an increased understanding of the array of ethical concerns that can arise. We discuss these concerns in light of commonly held ethical requirements for clinical research (social or scientific value, scientific validity, fair subject/participant selection, favourable risk-benefit ratio, independent review, informed consent, and respect for potential and enrolled participants) and refer to guidelines specifically developed for participatory research in health promotion. We draw from our community-based experiences in mental health promotion research with immigrant and culturally diverse youth to illustrate the ethical advantages and challenges of applying a PAR approach. We conclude with process suggestions for Research Ethics Boards.     

Exporting DBCP and other banned pesticides: consideration of ethical issues.

Many developed countries permit the export of pesticides that are banned, restricted, or unregistered within their own borders. This practice, which leads to the exposure of agricultural workers in developing countries to high levels of pesticides that are not permitted in the country of manufacture, raises many ethical issues as well as economic, social, political, and public health issues. Worldwide attempts to control export of such pesticides, through the FAO/UNEP Prior Informed Consent program, moves this issue in the right direction. This article explores the current U.S. and international practices, using the specific example of export of DBCP to banana-producing countries. The actions taken by multinational corporations, manufacturers of the pesticides, and public health officials in both the exporting and importing countries are explored, along with the impacts on workers, local economies, governments, and the environment.     

Researching domestic violence against women: methodological and ethical considerations

The results of three population-based studies on violence against women in Nicaragua are compared in this article. Two of the studies were regional in scope (León and Managua) and focused specifically on women's experiences of violence, whereas the third study was a Demographic and Health Survey (DHS) conducted with a nationally representative sample of women. The lifetime prevalence estimates for women's undergoing physical violence from a partner were significantly higher in the León study (52 percent) and Managua study (69 percent), compared with that given in the DHS (28 percent). Possible explanations for the differences are examined through pooled multivariate logistic regression analysis, as well as analysis of six focus-group discussions carried out with field-workers and staff from the three studies. The most important differences that were found concerned ethical and safety procedures and the interview setting. The results indicate that prevalence estimates for violence are highly sensitive to methodological factors, and that underreporting is a significant threat to validity.     

Body identification, biometrics and medicine: ethical and social considerations

Identity is important when it is weak. This apparent paradox is the core of the current debate on identity. Traditionally, verification of identity has been based upon authentication of attributed and biographical characteristics. After small scale societies and large scale, industrial societies, globalization represents the third period of personal identification. The human body lies at the heart of all strategies for identity management. The tension between human body and personal identity is critical in the health care sector. The health care sector is second only to the financial sector in term of the number of biometric users. Many hospitals and healthcare organizations are in progress to deploy biometric security architecture. Secure identification is critical in the health care system, both to control logic access to centralized archives of digitized patients' data, and to limit physical access to buildings and hospital wards, and to authenticate medical and social support personnel. There is also an increasing need to identify patients with a high degree of certainty. Finally there is the risk that biometric authentication devices can significantly reveal any health information. All these issues require a careful ethical and political scrutiny.     

Conducting research with young children: some ethical considerations

The recent foundation of a 'Young Children's Perspectives' special interest group in the European Early Childhood Education Research Association (EECERA) reflects a general move in social research towards the respectful and inclusive involvement of children in the research process. However, established education research guidelines often provide no more than a loose ethical framework, appearing to focus on avoiding poor ethical conduct rather than proposing ways forward for making children's participation in research a positive experience. This short paper draws on my own experiences of conducting ESRC-funded ethnographic video case studies on the ways four three-year-old children express their understandings at home and in a preschool playgroup during their first year of early years education. The paper reflects on the processes of negotiating initial and ongoing consent, problematises the notion of 'informed' consent in exploratory research with young children, and considers questions of anonymity when collecting and reporting on visual data. The paper proposes that by adopting a flexible, reflective stance, early years researchers can learn much from children, not only about their perspectives, but also about how to include young children in the research process.     

Conducting research with young children: some ethical considerations

The recent foundation of a ‘Young Children's Perspectives’ special interest group in the European Early Childhood Education Research Association (EECERA) reflects a general move in social research towards the respectful and inclusive involvement of children in the research process. However, established education research guidelines often provide no more than a loose ethical framework, appearing to focus on avoiding poor ethical conduct rather than proposing ways forward for making children's participation in research a positive experience. This short paper draws on my own experiences of conducting ESRC‐funded ethnographic video case studies on the ways four three‐year‐old children express their understandings at home and in a preschool playgroup during their first year of early years education. The paper reflects on the processes of negotiating initial and ongoing consent, problematises the notion of ‘informed’ consent in exploratory research with young children, and considers questions of anonymity when collecting and reporting on visual data. The paper proposes that by adopting a flexible, reflective stance, early years researchers can learn much from children, not only about their perspectives, but also about how to include young children in the research process.