Ethical Flaws Research Articles

Toward a General Theory of Research Ethics

Two seemingly distinct principles have dominated the ethics of human subjects research. On the one hand, based on the importance of personal autonomy, we require the informed consent of subjects who have decisional capacity, and provide special protections to those who lack such capacity. Separately, however, we also impose a variety of substantive restrictions on the conduct of studies. But do we really need two principles? Franklin Miller and Alan Wertheimer have produced a rich, elegantly argued essay suggesting that much of research ethics, as it relates to studies intended for adults with decisional capacity, can be derived from a single intriguing concept. They name it soft paternalism. Their line of reasoning proceeds as follows: First, because we cannot always accurately determine when someone has decisional capacity, people who lack sufficient capacity are regularly enrolled in such studies. To protect them from harm, we allow the studies to be conducted only if they adhere to various substantive restrictions, including specified risk-benefit criteria. These rules infringe on the autonomy of fully competent subjects. They prevent them from enrolling in studies that might otherwise have been conducted if there weren't any risk-benefit restrictions. The name soft paternalism refers to the general policy of protecting from harm the members of a group that have impaired judgment, but for practical reasons applying that policy to all members of the group. Much of Miller and Wertheimer's discussion is devoted to an intricate and convincing demonstration of why group soft paternalism--which, as they forthrightly acknowledge, some people would claim is not truly paternalism--does not unethically infringe on anyone's autonomy. But one of their further claims--that this construct provides an explanation for the existing research rules relating to risks and benefits--seems less convincing. Imagine that the existing rules had been specifically crafted to deal with the authors' hypothesized scenario that many people who lack decision-making capacity are regularly enrolled in studies designed for competent adults. If that were the case, then those rules have a huge ethical flaw. Why? Because the risk-benefit rules that Miller and Wertheimer are trying to justify don't require that, from a subject's viewpoint, the benefits outweigh the risks. Far from it. They merely require that the benefits to the subject, combined with the benefits to society from the knowledge to be gained, must be reasonable relative to the risks. …

Rhetorical Distance in "Letter from Birmingham Jail"

This essay explores the concept of rhetorical distance as the counterpart of esthetic distance. Rhetorical distance functions as a critical lens through which one may view Martin Luther King Jr.'s "Letter from Birmingham Jail." It reveals King's artistry in controlling an array of implied symbolic spatial relationships to achieve rhetorical ends. Chief among these relationships are those that divided King from his ostensible audience, his ostensible audience from his actual audience, his actual audience from that level of illumination required for them to grasp the issues agitated by King's movement, and the chasm that separated African Americans from the heritage promised them by mythic America. The essay revisits more precisely the contrasts between rhetoric and poetic, and explores a tragic ethical flaw that may lie at the heart of the human communication condition. The essay concludes by considering how the "Letter"'s rhetoric served the prevailing journalistic melodrama and by connecting its work to the functions of rhetorical depiction.

Bioethics of the refusal of blood by Jehovah's Witnesses: Part 1. Should bioethical deliberation consider dissidents' views?

Jehovah's Witnesses' (JWs) refusal of blood transfusions has recently gained support in the medical community because of the growing popularity of "no-blood" treatment. Many physicians, particularly so-called "sympathetic doctors", are...

Managed care: rationing without justice, but not unjustly.

Three ethical criticisms of managed care are often voiced: (1) by "skimming the cream" of the patient population, managed care organizations fail to discharge their obligations to improve access, or at least, to not worsen it; (2) managed care organizations engage in rationing, thereby depriving patients of care to which they are entitled; and (3) by pressuring physicians to ration care, managed care organizations interfere with physicians' fulfillment of their fiduciary obligations to provide the best care for each patient. This article argues that each of these criticisms is misconceived. The first rests on the false assumption that the health care system includes a workable division of responsibility regarding access that assigns obligations concerning access to managed care organizations. The second and third criticisms wrongly assume that we in the United States have taken the first step toward assuring equitable access to care for all, articulating a standard for what counts as an "adequate level of care" to which all are entitled. These three misguided criticisms obscure the most fundamental ethical flaw of managed care: the fact that it operates in an institutional setting within which no connection can be made between the activity of rationing and the basic requirements of justice.

Myth, Ethos, and Actuality: Official Art in Fifth Century B.C. Athens

Myth, Ethos, and Actuality examines the depiction of mythic themes on Athenian public monuments in the period following the Persian Wars, during the second and third quarters of the 5th century BC. Using material remains, as well as the evidence of contemporary Greek history, rhetoric and poetry, David Castriota interprets the Athenian monuments as vehicles of an official ideology intended to celebrate and justify the present in terms of the past. Castriota focuses on the strategy of ethical antithesis asserting Greek moral superiority over the barbaric Persians, whose invasion had been repelled a generation earlier. He examines how, in major public programmes of painting and sculpture, the leading artists of the period recast the Persians in the guise of wild and impious mythic antagonists to associate them with the ethical flaws or weakness commonly ascribed to women, animals and foreigners. The Athenians in contrast, were compared to mythic protagonists representing the excellence and triumph of Hellenic culture. Castriota's study attempts to break new ground in emphasising the ethical implication of mythic precedents, which required substantial alterations to render them more effective as archetypes for the defence of Greek culture against a foreign, morally inferior enemy. The book looks at how the patrons and planners sought to manipulate viewer response through the selective presentation or repackaging of mythic traditions.

Splitting embryos on the slippery slope: ethics and public policy.

Neither the George Washington University embryo splitting experiment nor the technique of embryo splitting itself has ethical flaws. The experiment harmed or wronged no one, and the investigators followed intramural review procedures for the experiment, although some might fault them for failing to seek extramural consultation or for not waiting until national guidelines for research on preembryos were developed. Ethical objections to such cloning on the basis of possible loss of individuality, possible lessening of individual worth, and concern about potential harm to the resulting children are discussed and challenged, as are objections to the creation of embryos for the purpose of genetic diagnosis. Many of the ethical questions raised by the George Washington experiment are similar to those posed by existing reproductive technologies that allow the simultaneous production of several embryos. A multidisciplinary group should consider whether regulation of cloning is needed, and laws should be enacted to prohibit a commercial market for all frozen embryos.

Radiation: Balancing the Record

This article reviews the radioactivity experiments performed on humans during the cold war, and examines the ethics of the experiments. The radiation experiments can be broadly classified into three groups: researchers knowingly inflicted potential harm, using methods questionable even by the then-current standards; the investigations involved good work by any standards with appropriate safeguards taken; and a third group which falls between the other two, the experiments provided useful information but had ethical flaws. The article also examines the experiments in the light of changing knowledge and moral standards.