Research Ethics

By
Tilaye Workineh
(BSc, MPH/Epid, Asst. Prof. of Epidemiology)

June 2021
Outlines

 Introduction
 Ethics and Law
 Ethical principles

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Introduction
 Ethics- Greek word- Ethos- means custom or culture, a manner
of acting or constant mode of behavior
 Ethics is defined as a science of moral reasoning
 Ethics is the study of standards of conduct and moral
judgment.
 It is not law, regulations or directives
 Ethics is a branch of philosophy that deals with distinctions
between right and wrong – with the moral consequences of
human actions
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Introduction . . .

 Ethics is the enterprise that determines norms and values to

guide the systematic reflection and scientific evaluation

or
 Assessment of knowledge and any form of experimentation or
survey, with the prime objective of health care (Ethiopian
Science and Technology Commission 2005)

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Ethics in Epidemiology
 Ethical principles that arise in epidemiologic practice and
research include:
 Respect for human rights- we ought to respect the right to self-
determination
Autonomy/Informed consent/-
Confidentiality-

 Beneficence- we ought to further others’ legitimate interests

 Justice- we ought to ensure fair entitlement to resources
Non-Maleficence- we ought not to inflict evil or harm

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 Ethics and Values
 Fundamental ethical and basic scientific values support mission and
purpose of the profession
 Valuesare the rules by which we make decisions about right and
wrong, should and shouldn't, good and bad
 They also tell us which are more or less important
 Valuesin the profession may gradually evolve over time e.g.
euthanasia
 Morals have greater social element to values & tend to have very
broad acceptance. Morals are far more about good & bad than
other values. We thus judge others more strongly on morals than
values
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Why Ethics in PH ?

 Health is sensitive to individual, family and country

 Most individual/community do not protect them selves
 Vulnerable popn group need special care
 Drug and medical procedure vulnerability for abuse
 Etc ………………….

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Ethical Issues

 Responsibility to protect society

 Responsibility to protect individual
 Government responsibility
 Corporate responsibility
 Right to health care
 Personal responsibility - self care
 Quality vs Equity of care
 Freedom of choice
 Acting on evidence vs. not acting

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Law and Ethics
 Gov’t obligation to protect health of the population
 Power of government to legislate, tax, spend, regulate, punish
 Restriction of personal and business liberties e.g. seat belt laws;
smoking restrictions vs human rights
 Economic, social impact of intervention vs non-intervention e.g.
inequities of the poor and rural
 Laws enacted by legislative bodies
 Court decisions
 Accountability
* Ethics need protection from law…*

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Individual Rights and Ethical Issues
 Right to quality health services
 Provider responsibility to act for benefit of client
 Euthanasia - right to die
 Confidentiality – right to privacy
 Informed consent – right to know
 Birth control – religion vs. individual rights
 Supply and distribution of resources for health
 Incentives - disincentives
 Equity – social, ethnic, regional
 Social solidarity
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Groups at Special Risk
 Women
 Children
 Civilians in war and terror situations
 Disaster victims
 Native peoples
 Minority groups
 Prisoners
 Military
 Refugees and internal migrants
 Mentally ill
 Rural vs. urban

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 Public Health: “the Slippery Slope” . . . .pave way for
ethical rule dev’t
 1920’s-1930’s: Eugenics movement

 1930’s-1940’s: Mass sterilization of "defectives" in United States

and Sweden.
 1930-1940’s: Mass murder of “defectives” in Germany (750,000)

 1940’s: Quarantining as pretext for ghettos by Nazis

 1940s: Concentration camps, human experimentation

 1940s: The Holocaust (6 million Jews and others)

 1946 – Nuremberg Trials

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. . . . the Slippery Slope . . .
 Atrocities committed during World War II in the Nazi
Germany which led to the 1947 Nuremberg Code of
Practice and in turn the 1964 Declaration of Helsinki
 Tuskegee Syphilis Study in USA (1932-1970s) to study the
long-term effects of untreated syphilis- 400 men out of the
600 participants were never told about the infection and
were never treated despite the fact that treatment became
available
 A study to examine the natural progression of cervical
carcinoma in New Zealand (1980s)-conventional treatment
was withheld from women in trial and women were not
asked for their consent
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In Summary

 Before you embark on research with human subjects, you

are likely to require ethical approval
 You may wonder why all this bureaucracy is needed
 But, history shows us that prior to the dev’t of ethical and
human rights over the last 40 years, patients’ rights were
often ignored and many individuals were seriously harmed
by medical research/experimentation

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Tips

 Generating information with out proper approach is ethically

not allowed
 So, ethics rounds all issues related to research/experiment
 system /approach/ appropriateness
 Harm vs benefit
 Autonomy, consent, ……………..

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  Good b y e !!!

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