Core Ethics for Health Professionals : Principles, Issues, and Compliance

154 Pages·2017·2.649 MB·English

by  Phalen, Robert F

Robert F. Phalen
Core Ethics
for Health
Professionals
Principles, Issues, and Compliance
Core Ethics for Health Professionals
Robert F. Phalen
Core Ethics for Health
Professionals
Principles, Issues, and Compliance
Robert F. Phalen
Department of Medicine
University of California
Irvine, CA, USA
ISBN 978-3-319-56088-5 ISBN 978-3-319-56090-8 (eBook)
DOI 10.1007/978-3-319-56090-8
Library of Congress Control Number: 2017943958
© Springer International Publishing AG 2017
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Preface
In preparing this book, I engaged dozens of professional and lay persons in conver-
sations about ethics. I heard many quips that were thought provoking. Some stood
out: (1) “Ethics is now just management of the risk of litigation” (physician); (2)
“I have no ethics” (personal trainer); (3) “My main ethical consideration is not
cross- contaminating my clients” (doctor’s assistant); (4) “The biggest ethical
problem is greed” (dental hygienist); (5) “Doing what’s right for my patients”
(nurse); and (6) “Oh No!” (ethicist on hearing about the other comments). I came
to realize that broadening one’s understanding of ethics is more important than
seeking simple rules.
Two questions must be dealt with. Is this book needed? And am I qualified to
write it? An Amazon search indicates that more than one hundred thousand ethics-
related books already exist. None are a concise student- and teacher-friendly text-
book that provides an overview of topics relevant to health professionals. I served
7 years as chair of the University of California, Irvine (UCI), Institutional Review
Board (IRB) on human studies. During that time, my committee reviewed about
1,000 human studies for our medical school. Following that sobering and enlighten-
ing period, I spent 7 years on the UCI Institutional Animal Care and Use Committee
(IACUC) and served as its chair for 1 year. During that time, the IACUC reviewed
hundreds of animal protocols and obtained AAALAC accreditation. I have provided
formal ethics training for faculty investigators, university staff, undergraduate and
graduate students, occupational medicine residents, and high school student
researchers. I also served as a university spokesperson on animal research. I have
had countless media interviews and appearances and written several book chapters
related to research ethics. I currently chair the Board of Directors for the California
Society for Biomedical Research and recently chaired our School of Medicine’s
Continuing Medical Education Committee. Still, I consider myself a student of
real- world ethics.
This book is designed for use in a variable-length introductory course. It is based
on a syllabus that was written for teaching ethics to graduate students and medical
residents. It includes cases of health professionals who unexpectedly had their
careers disrupted by ethics violation charges, some iconic scandals and their impacts,
v
vi Preface
formal ethics philosophy, codes of conduct, regulations, guidelines and policies,
research ethics, online training, unsolved problems, and a chapter designed to keep
professionals out of trouble as they strive to succeed in their careers. An author-
generated Index and answers to quiz questions are available at the end.
This book is designed to shift reader’s thinking and ethics-related behavior to
higher levels. The intended readers include students and practitioners in the health
sciences, researchers who use human subjects or laboratory animals, administrators
who oversee health science training or biomedical research, and anyone who is
interested in real-world ethics.
Many people unselfishly contributed to this book, and I thank them all. Leslie
Owens, Administrative Assistant, tirelessly solved the difficult administrative and
practical problems to make this book possible. Molly Belikov, Carolyn Spence, and
Michelle Feng He, Springer Toxicology Editors, provided encouragement and made
countless invaluable suggestions about content and style. Dr. William Harper,
Emeritus Professor of Philosophy, arranged reviews of several chapters. These
reviewers, philosophers associated with the University of Western Ontario in
Canada, were Dr. Charles Weijer and Dr. Anthony Skelton. Dr. Lynn Bevill, a psy-
chologist, critiqued two chapters. Stevern R. McKinney, an OSHA administrator,
provided reviews of two chapters. Kathryn E. Terry, Attorney at Law, tried to keep
my logic tight and the writing sharp. Dr. Felicia Cohn, an ethicist at the University
of California at Irvine, suggested several key textbook references. Dr. Michael
S. Perkins, a Texas physician, and Dr. Catherine Boomus, Occupational Medicine
Residency Director at U.C. Irvine, contributed insights about the real world and
helped me believe that this book was important to write. Cheryl McCants-Perkins,
Intellectual Property Administrator, generously shared her insights. Stewart
T. Kimura, MS Counseling, educated me on online security and contributed impor-
tant text to the chapter on training. My wife, Katherine S. Phalen, Occupational
Health Nurse; sister, Nancy D. Phalen; and son, Steven B. Phalen, designed and
prepared the illustrations, checked the references, and contributed nursing-related
and other insights. Tuan Nguyen, CIH, CSP, ARM, prepared figure 1.2, and inspired
the other figures. DJ Wanda, host of KUCI-FM’s “Howdydelicious,” broadcast
uplifting music that energized many late-night writing sessions. My and Leslie’s
families supported us and suffered neglect during the preparation of this book. All
of the above contributors are acknowledged and sincerely appreciated. However, I
am solely responsible for all of the deficiencies and invite your suggestions for
improvements.
Irvine, CA Robert F. Phalen
January, 2017
[email protected]
Contents
1 Introduction ............................................................................................ 1
1 Introduction ....................................................................................... 1
2 Thinkers and Theories ....................................................................... 4
3 Two True Stories................................................................................ 5
4 Overview of the Chapters .................................................................. 7
5 Summary ........................................................................................... 9
References ................................................................................................ 10
2 Scandals and Their Legacies ................................................................. 13
1 Introduction ....................................................................................... 13
2 The Dark Side of Science .................................................................. 14
3 Scientific Fraud ................................................................................. 15
4 Human Research Scandals ................................................................ 17
5 Ethics Guidelines ............................................................................... 21
6 Lessons Learned ................................................................................ 25
7 Summary ........................................................................................... 25
References ................................................................................................ 27
3 Philosophical and Practical Ethics ....................................................... 29
1 Introduction ....................................................................................... 29
2 The Scope of Ethics ........................................................................... 31
3 Ethics Theories .................................................................................. 32
4 Practical Ethics .................................................................................. 34
5 Codes of Conduct .............................................................................. 35
6 Concepts to Ponder ............................................................................ 36
7 Summary ........................................................................................... 37
References ................................................................................................ 38
4 Regulations, Guidelines, and Policies ................................................... 39
1 Introduction ....................................................................................... 39
2 Human Studies .................................................................................. 43
3 Clinical Practice ................................................................................ 46
vii
viii Contents
4 Laboratory Animal Studies ................................................................ 46
5 Publication Guidelines ...................................................................... 47
6 Summary ........................................................................................... 47
References ................................................................................................ 48
5 Laboratory Research ............................................................................. 51
1 What Is Research? ............................................................................. 51
2 The Research Imperative ................................................................... 52
3 Elements of Research Ethics ............................................................. 53
4 Obligations of Researchers ................................................................ 55
5 Records, Including Laboratory Notebooks ....................................... 56
6 Cheating ............................................................................................ 59
7 More on Publishing ........................................................................... 59
8 Summary ........................................................................................... 59
References ................................................................................................ 61
6 Compliance and Online Training ......................................................... 63
1 Introduction ....................................................................................... 63
2 Online Security .................................................................................. 64
3 Compliance ........................................................................................ 68
4 Required and Recommended Training .............................................. 68
5 Summary ........................................................................................... 71
References ................................................................................................ 73
7 Professional Ethics ................................................................................. 75
1 Introduction ....................................................................................... 75
2 The Health Professions ...................................................................... 77
3 Ethical Principles for Health Professionals ....................................... 78
4 More on Codes of Conduct and Oaths .............................................. 81
5 Threats to Professional Ethics ........................................................... 84
6 Summary ........................................................................................... 85
References ................................................................................................ 86
8 Crimes Against Science, Scientists, and Health Professionals ........... 87
1 Introduction ....................................................................................... 87
2 Historical Cases ................................................................................. 88
3 Why Is Science a Target? .................................................................. 89
4 Is Academic Freedom in Trouble? .................................................... 92
5 Defenders........................................................................................... 94
6 The Future ......................................................................................... 95
7 Summary ........................................................................................... 97
References ................................................................................................ 98
9 Public Perceptions .................................................................................. 101
1 Introduction ....................................................................................... 102
2 The Deficit Model of Trust ................................................................ 103
3 Who Does the Public Trust? .............................................................. 103
Contents ix
4 Effect of Gender ................................................................................ 105
5 The Media.......................................................................................... 105
6 Legislators ......................................................................................... 106
7 Threats to Trust in Science ................................................................ 107
8 Public Perception of Risks ................................................................ 108
9 Summary ........................................................................................... 111
References ................................................................................................ 113
10 Unsolved Problems: Our Brave New World ........................................ 115
1 Introduction ....................................................................................... 116
2 Genetic Science and Engineering ...................................................... 117
3 Fertility Issues ................................................................................... 118
4 Euthanasia and Life Extension .......................................................... 120
5 Terrorism and Military Activities ...................................................... 122
6 Privacy and Electronic Data .............................................................. 124
7 Virtual Worlds.................................................................................... 125
8 Big Brother ........................................................................................ 126
9 Artificial Intelligence ......................................................................... 126
10 Ethics and Complex Systems ............................................................ 127
11 Comments on the Future ................................................................... 129
12 Summary ........................................................................................... 129
References ................................................................................................ 131
11 A Better Future (A Survival Guide) ..................................................... 133
1 Introduction ....................................................................................... 133
2 The Nature of the Problem ................................................................ 134
3 Errors of the Past and Their Repercussions ....................................... 135
4 Avoiding Future Scandals .................................................................. 137
5 Already in Trouble? ........................................................................... 138
6 Summary ........................................................................................... 140
References ................................................................................................ 143
Appendix: Quiz Key ....................................................................................... 145
Index ................................................................................................................ 147
Chapter 1
Introduction
Contents
1 Introduction .......................................................................................................................... 1
2 Thinkers and Theories .......................................................................................................... 4
3 Two True Stories .................................................................................................................. 5
4 Overview of the Chapters .................................................................................................... 7
5 Summary .............................................................................................................................. 9
References .................................................................................................................................. 10
Learning Objectives
After reading this chapter, one should be able to:
• Discuss the various definitions of “ethics”
• Explain why the study of ethics is important to health professionals
• Compare and contrast virtue ethics and utilitarian ethics
• Describe a case of well-intentioned professional behavior gone wrong
1 Introduction
Defining “Ethics”
Most definitions of “ethics” fall into one of several categories. Ethics refers to:
• The rules for acceptable moral conduct
• The decisions and actions one makes that reflect one’s values
• A system of moral principles or the principles themselves
• A branch of philosophy
The first two definitions are both the most ambiguous and the most important for
health professionals. What constitutes acceptable conduct depends upon the specific
circumstances, who is the actor, what are the options, and who is judging the
© Springer International Publishing AG 2017 1
R.F. Phalen, Core Ethics for Health Professionals,
DOI 10.1007/978-3-319-56090-8_1