Ethics in research

1
Ethics in research

• Biomedical research ethics came about as a result
  of abuse to research participants in the past
• Nazis concentration camp experiments
• The Tuskegee Syphilis Study
• Research was often carried out on prisoners,
  orphans, or mentally ill many times without the
  subjects knowledge

2
Ethics in research (cont.)

• The Nuremberg Code (1947)
• Developed from the Nuremberg Military Tribunals
• Had no legal authority (unenforceable)
• Only dealt with research on healthy participants
• Left the control of research entirely up to
  scientists

3
Ethics in research (cont.)

• Declaration of Helsinki (1964)
• Developed by the World Medical Association to
  remedy deficiencies of the Nuremberg Code
• Has been amended five times, most recently in
  2000
• Required medical researchers to clearly define
  study protocols
• Protocols had to be submitted to independent
  ethical review committees (IRB) for approval

4
Ethics in research (cont.)

• The Belmont Report (1979)
• Included 3 principles of research ethics
• Autonomy the principle of respect for persons
  especially those with diminished autonomy
• Beneficence supports the well-being of research
  subjects by maximizing benefits while minimizing
  harms
• Justice the distribution of the benefits,
  burdens, and risks of research should be
  equitable between societal groups

5
Informed consent

• Nuremberg Code
• . . . the voluntary consent of the human subject
  is absolutely essential.
• Belmont Report
• Respect for research participants
• Research subjects must be given the opportunity
  to choose what shall or shall not happen to them

6
Informed consent (cont.)

• Signed informed consent must be obtained from
  every research participant
• However, it is a process, not just a form
• The document should be thought of as a teaching
  tool, not as a legal instrument
• The document must be written in lay language
  that is understandable to the people being asked
  to participate

7
Informed consent (cont.)

• The consent document should explain
• The purpose of the research
• The benefits and risks
• Confidentiality matters
• A study contact person if questions arise
• That participation is voluntary and subjects have
  the right to withdraw at any time
• How adverse events are dealt with

8
Chiropractic philosophy and EBC

• The foundation of chiropractic includes
  philosophy, science, art, knowledge, and clinical
  experience. The
  Chiropractic Paradigm The Association of
  Chiropractic Colleges
• However, many chiropractors have a limited
  understanding of the concepts of philosophy

9
Philosophy and EBC (cont.)

• Many chiropractors think of philosophy as it
  relates to their fundamental beliefs and
  underlying principles about the profession
• Thus, one is said to have a philosophy of
  chiropractic
• This perception only comprises a small part of
  the words complete definition

10
Philosophy definition

1. The love and pursuit of wisdom by intellectual
   means and moral self-discipline
2. Investigation of the nature, causes, or
   principles of reality, knowledge, or values,
   based on logical reasoning rather than empirical
   methods
3. The critical analysis of fundamental assumptions
   or beliefs
4. A set of ideas or beliefs relating to a
   particular field or activity an underlying
   theory
5. A system of values by which one lives

11
Philosophy and dogma

• A belief system taken to an extreme becomes
  dogma defined as
• An authoritative principle, belief, or statement
  of ideas or opinion, especially one considered to
  be absolutely true
• Dogmatic practitioners may be reluctant to
  acknowledge new information and change their
  practices in response

12
Dogmatism

• The chiropractic profession at large is plagued
  with dogmatism that affects both sides of the
  political fence Seaman
• Dogmatism is the principle barrier to a rational
  and unifying depiction of the role of
  chiropractors, as well as the furtherance of
  chiropractic science Keating

13
The solution for dogmatism

• When used effectively, philosophy leads to a
  willingness to critically examine ones beliefs
• Rather than being dogmatic, one should welcome
  new (better) evidence and try to incorporate it
  into patient care

14
EBC and philosophy are complementary

• There are no sacrosanct truths in chiropractic
  that should never be questioned
• Any conceivable chiropractic-related topic should
  be open for discussion