Unique Ethical Challenges Research Articles

Military operational psychology.

With increasing requirements for expeditionary support to military units, models of integrated and embedded psychology have emerged. Operational psychology represents one such model. Military operational psychologists receive specialized training, are embedded in operational units, and are employed to provide operational mission support to organizations and their personnel as opposed to providing individual health care per se. The following article describes the employment of military operational psychology and discusses its unique organizational and ethical challenges. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Nurses' tension-based ethical decision making in rural acute care settings.

Nurses in acute care are frequently involved in ethical decision making and experience a higher prevalence of ethical conflicts and dilemmas. Nurses in underresourced rural acute care settings also are likely to face unique ethical challenges. However, rarely have the particular contexts of these experiences in rural acute care settings been researched. A culture of silence and fear in small towns has made exploring these issues difficult. To explore registered nurses' experiences of ethical issues and ethical decision making in rural acute care hospitals in northern Ontario, Canada. Guided by an interpretive descriptive approach, data were collected by two nurse researchers using in-depth, individual, and semistructured telephone interviews. Data were managed with NVivo v.11 and analyzed using inductive, comparative, thematic analyses. The participants were eight registered nurses working in two acute care hospitals in northern Ontario. Ethical protocols were followed in accordance with ethics approval from the researchers' university and the hospitals. Results identified four themes that culminated in the development of a quadruple helix ethical decision-making framework of power, trust, care, and fear. The participants described complex ethical conflicts and dilemmas in acute care settings that were influenced by the context of working and living in small rural communities in northern Ontario. Nurses described navigating ethics in practice using a tension-based approach to ethical decision making, needing to carry these issues silently and often having no resolution to ethical challenges. These findings have important implications for nursing education, research, and practice. Nurses need safe spaces, formal ethics support, and improved access to resources. Additional ethics education and training specific to the unique contexts of rural settings are needed.

Clerkship Ethics: Unique Ethical Challenges for Physicians-in-Training.

Three ethical conflicts in particular are paradigmatic of what we define as "clerkship ethics." First, a distinction that differentiates the clerkship student from the practicing physician involves the student's principal role as a learner. The clerkship student must skillfully balance her commitment to her own education against her commitment to patient care in a fashion that may compromise patient care. While the practicing physician can often resolve the tension between these two goods when they come into conflict, the clerkship student is left with a more ambiguous set of choices. Second, evaluative scrutiny during clinical clerkships often forces medical students to balance doing what is morally fitting against the perceived expectations of the medical teams in which they work. Third and finally, a deeply entrenched culture of medical hierarchy presents a particular challenge to innovation and improvement in ethics education during the clerkship years. Students regard faculty as exemplars, but are not provided with the tools to assess when technical medical competence is not matched by moral competence; moreover, these faculty are unlikely to have experienced the ethics education in which students are asked to demonstrate mastery.

First Ready, First to Go: Ethical Priority-Setting of Allogeneic Stem Cell Transplant at a Major Cancer Centre.

Medical advancements have now made it possible to provide allogeneic stem cell transplantation (allo-SCTs) to older patients and use stem cells from less well-matched donors. This has resulted in access to a life-saving modality for a greater number of patients with imminent life-threatening illnesses. However, resources have not always kept pace with innovation and expanded volumes. During the summer of 2015 in the province of Ontario, Canada, inadequate resources contributed to a capacity crisis, resulting in extended wait-lists for allo-SCT across the province. This situation presented unique ethical challenges, including the need for ongoing negotiations with health system partners and nimble process management to ensure timely delivery of care. This article reports on the process one organization used to determine how to equitably allocate scarce allo-SCT resources. With the ever-expanding landscape of new and emerging medical technologies, our experience has implications for the ethics of translating other increasingly expensive health technologies to clinical care.

Guidelines and Recommendations for Training Ethical Alcohol Researchers.

Research on alcohol use presents several ethical challenges, and therefore, training of ethical alcohol researchers is particularly important. While the Helsinki Declaration (World Medical Association, 2001), Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978), and American Psychological Association's (APA) Ethics Code (2002) provide ethical guidelines and aspirational principles for researchers, there are a number of areas in which these principles allow for judgment. For trainees in particular, this ambiguity may be disconcerting. Along with these broader principles, there are also specific considerations for training alcohol researchers in the responsible conduct of research, which may further complicate matters for trainees. Although alcohol research is an important avenue for understanding a large public health concern and investigating risk and protective factors associated with use, it also presents a number of ethical and legal challenges for researchers. Working with high-risk drinking populations presents unique ethical and legal challenges in the areas of informed consent, confidentiality, compensation, and risk-benefit ratios. Additionally, alcohol administration studies present challenges for those supervising, as well as conducting, such experiments. New technology, such as the use of ecological momentary assessment (EMA) or other ambulatory assessment methods to examine risky and illegal behaviors, also presents new ethical challenges that are likely to continue to evolve in the coming years for trainees. Specific recommendations for handling a variety of concerns that may arise when conducting alcohol research are provided. Additionally, suggestions for improving the training of ethical alcohol researchers are discussed.

Are we ready to share qualitative research data? Knowledge and preparedness among qualitative researchers, IRB Members, and data repository curators.

Data sharing maximizes the value of data, which is time and resource intensive to collect. Major funding bodies in the United States (US), like the National Institutes of Health (NIH), require data sharing and researchers frequently share de-identified quantitative data. In contrast, qualitative data are rarely shared in the US but the increasing trend towards data sharing and open science suggest this may be required in future. Qualitative methods are often used to explore sensitive health topics raising unique ethical challenges regarding protecting confidentiality while maintaining enough contextual detail for secondary analyses. Here, we report findings from semi-structured in-depth interviews with 30 data repository curators, 30 qualitative researchers, and 30 IRB staff members to explore their experience and knowledge of QDS. Our findings indicate that all stakeholder groups lack preparedness for QDS. Researchers are the least knowledgeable and are often unfamiliar with the concept of sharing qualitative data in a repository. Curators are highly supportive of QDS, but not all have experienced curating qualitative data sets and indicated they would like guidance and standards specific to QDS. IRB members lack familiarity with QDS although they support it as long as proper legal and regulatory procedures are followed. IRB members and data curators are not prepared to advise researchers on legal and regulatory matters, potentially leaving researchers who have the least knowledge with no guidance. Ethical and productive QDS will require overcoming barriers, creating standards, and changing long held practices among all stakeholder groups.

Development of the myocite biobank: Cost-efficient model of public sector investigator-driven biobank for idiopathic inflammatory myositis

Background: Biobanking refers to the cryopreservation of the various biologic samples for future research. In the era of omics, biobanking has emerged as a vital process to aid research, more so for rare diseases. Aims and Methods: We describe herein the development of a biobank for idiopathic inflammatory myopathies (IIMs), a rheumatic illness with low prevalence. This study addresses the sample collection, transport, storage, maintenance, retrieval, and disposal of samples with a focus on cost-effectiveness, limitations, ethics, and legal aspects involved. Discussion: Financial constraints are juxtaposed next to a wealth of clinical data in the developing countries with a large population size and consequently high burden of rare diseases. Fine-tuning efforts toward the development of bio-archival facilities can maximize outcomes from research units in these countries. A time and cost-efficient model can be the first step toward such initiatives in the appropriate setting. Unique ethical, executive, and scientific challenges were encountered by the authors while establishing the MyoCite biobank in a resource-poor setting. The various efforts to foreclose these obstacles are discussed. Conclusion: This brief summarizes the unmet need, unique challenges, and potential solutions based on the authors' experiences gathered while setting up the MyoCite biobank for research in IIM. It also outlines the means and directions for national and global collaborations in the times ahead.

Applying Unoccupied Aircraft Systems to Study Human Behavior in Marine Science and Conservation Programs

The declining costs of Unoccupied Aircraft Systems (UAS, aka drones), their ease of use, and their ability to collect high resolution data from a variety of sensors has resulted in an explosion of applications across the globe. Scientists working in the marine environment are increasingly using UAS to study a variety of topics, from counting wildlife populations in remote locations to estimating the effects of storms and sea level rise on shorelines. UAS also provide transformative potential to study the ways in which humans interact with and affect marine and coastal ecosystems, but doing so presents unique ethical and legal challenges. Human subjects have property rights that must be respected, and they have rights to privacy, as well as expectations of privacy and security that may extend beyond actual legal rights. Using two case studies to illustrate these challenges, we outline the legal and regulatory landscapes that scientists confront when people are their primary study subjects, and conclude with an initial set of legal best practices to guide researchers in their efforts to study human interactions with natural resources in the marine environment.

The ethics of testing and research of manufactured organs on brain-dead/recently deceased subjects

Over 115 000 people are waiting for life-saving organ transplants, of whom a small fraction will receive transplants and many others will die while waiting. Existing efforts to expand the...

Ethical Considerations for Using School-Based Motivational Interviewing with Parents, Teachers, and Students

Recently, an increasing number of researchers and school psychologists have advocated for the use of School-Based Motivational Interviewing (SBMI) for working directly with students and for consulting with teachers and parents. However, little attention has been given to the possible ethical implications of school psychologists’ use of SBMI with various stakeholders in school settings. In this paper, unique ethical challenges are highlighted and recommendations for implementing SBMI techniques in relation to both MI ethical guidelines and the National Association of School Psychologists (NASP) Principles for Professional Ethics are provided.

Intergenerational monitoring in clinical trials of germline gene editing

Design of clinical trials for germline gene editing stretches current accepted standards for human subjects research. Among the challenges involved is a set of issues concerning intergenerational monitoring—long-term follow-up study...

Treatment of Students with Sexual Deviant or Offending Behaviors: Should College Counseling Centers Go There?

ABSTRACT In this article, the authors discuss the pathways to sexual offenses, risk factors, treatment, and unique ethical challenges inherent in working with students who have a history of sexual offending behavior or exhibit risk factors for such behavior. We also address unique clinical competencies and knowledge and provide recommendations for clinicians who find themselves in a position of having to work with such students despite contraindications. Finally, we explore the consideration of implementing a systems approach to mitigate risks posed by a student with sexual behavior problems by way of the college or university’s behavioral assessment or intervention team.

Rethinking resistance: public health professionals on empathy and ethics in the 2014-2015 Ebola response in Sierra Leone and Liberia

ABSTRACT Public health professionals may be confronted with unique ethical challenges in outbreak response situations. We conducted interviews with twenty-two public health professionals involved in responses to the 2014–2015 Ebola epidemic in Sierra Leone and Liberia to explore how they understood and experienced the ethical challenges involved in this work. The concerns covered in these interviews ranged dramatically, but three themes emerged as unique contributions from a subset of individuals integrally involved with the frontline response, who framed concerns about representation as key ethical issues. These included concerns regarding misrepresentations of West Africans as ‘resistant’ to the epidemic response, failures in material and information resources provided in the response, and representations of ‘rationality’ between responders and publics. Such concerns suggest that perspectives advanced in the critical public health literature in recent decades are circulating amongst public health professionals involved in outbreak response, although discord amongst respondents suggests the need for more deliberate efforts to reframe thinking about resistance, resources, and rationality in future public health outbreak responses.

Prodromes and Preclinical Detection of Brain Diseases: Surveying the Ethical Landscape of Predicting Brain Health.

The future of medicine lies not primarily in cures but in disease modification and prevention. While the science of preclinical detection is young, it is moving rapidly. Preclinical interventions offer hope to decrease the severity of a disease or delay the development of a disorder. With such promise, the research and practice of detecting brain disorders at a preclinical stage present unique ethical challenges that must be addressed to ensure the benefit of these technologies. Direct brain interventions have the potential to impact not just what a patient has but who they are and who they could become. Further, receiving an assessment for a preclinical or prodromal state has potential to impact perceptions about capacity, autonomy and personhood and could become entangled with stigma and discrimination. Exploring ethical issues alongside and integrated into the experimental design and research of these technologies is critical. This review will highlight ethical issues attendant to the current and near future states of preclinical detection across the life span, specifically as it relates to autism spectrum disorder (ASD), schizophrenia, and Alzheimer’s disease.

The Journey to a Wider Understanding of Ways of Knowing: Knowledge Translation and the Arts

In this commentary, educator and author Katherine Boydell reflects on her journey to incorporate art genres in the research process as a knowledge translation strategy for producing and disseminating research-informed knowledge. She highlights the need to move beyond descriptions of form and content to grapple with the unique methodological, theoretical, and ethical challenges of working with research participants, artists, and audience members engaging in this work. She describes some of her current arts-based research and identifies the current pressures to conform to expectations regarding “what counts” in academia and concludes with future suggestions to advance arts-based knowledge translation.

Uncontrolled deceased cardiac donation: An unutilized source for organ transplantation in the United States.

The practice of uncontrolled donation after cardiac death (uDCD) has been met with tepid interest within the United States transplant community. Hesitancy stems largely from fears of eroding public trust due to complex ethical issues involving consent. Beyond ethical concerns, uDCD creates unique logistic challenges to obtain and to preserve organs within a short time frame. This mandates that organ recovery centers be able to rapidly mobilize, and that traditional cold preservation techniques may be inadequate. Proof of effective uDCD organ recovery comes from several European nations, and the frequency of its use is increasing due to early promising results. These scarce resources provide life-saving organs to desperate transplant candidates who otherwise experience high morbidity and mortality on a transplant waitlist. The objective of this review will be to provide an overview of the European experience with uDCD and discuss the unique ethical and logistic challenges associated with its implementation in the United States. Given existing models for it successful use, uDCD remains a poorly utilized source of donors in the United States at this time.

Psychiatric Genomics, Phenomics, and Ethics Research In A 270,000-Person Biobank (BioVU)

BioVU is the Vanderbilt University Medical Center (VUMC) biobank of DNA extracted from discarded blood collected during routine clinical testing and linked to de-identified electronic medical records (EMRs). While DNA has been collected on 270,000 patients, EMRs for over 2.6 million patients are also available for phenotypic studies. I will describe results from three recent biobank initiatives including phenotypic, genetic, and ethical, legal and social issues (ELSI) research.Phenotyping initiative: In collaboration with the Tourette and Obsessive-Compulsive Disorder (OCD) Workgroup of the Psychiatric Genomics Consortium (PGC), we developed a phenotyping algorithm for the detection of OCD in the EMR. We utilized ICD 9 and 10 codes along with natural language processing (NLP) to detect diagnostic keywords (e.g., OCD, etc.), treatment keywords (e.g., cognitive-behavioral, etc.), and medications (i.e., venlafaxine, etc.) commonly prescribed for the treatment of OCD. Contextual information from 50 cases identified by the algorithm was then abstracted by trained non-expert reviewers and abstracted charts were reviewed by two domain experts to determine the positive predictive value (PPV) of the algorithm. We identified 7,547 potential cases in the EMR and PPV was high (> 92%) across the two reviewers when ICD codes, diagnostic keywords, and treatment keywords were present in case charts. I will present our algorithm development approach, pitfalls and challenges, validation measures, and patterns of comorbidity discovered within the EMR.Polygenic analysis initiative: We have developed an EMR-enabled biomarker discovery approach which leverages routinely collected clinical laboratory measurements available on >30,000 people with genetic data in BioVU. These lab measures such as complete blood counts or metabolic and immunoglobulin panels can be mined for novel biomarkers through polygenic risk score (PRS) analyses. In an initial experiment, we calculated PRS for triglycerides (PRStrigs) and coronary artery disease (PRSCAD) and demonstrate that each predictor, respectively, accounted for a significant proportion of the variance in mean triglyceride levels across the biobank (PRStrigs; R2 = 0.034; p = 4.2x10-27 and PRSCAD; R2 = 0.0051, p = 2.2x10-5) while adjusting for sex, age, and ancestry. In a separate analysis, we selected 53 putative biomarkers measured in the Atherosclerosis Risk in Communities (ARIC) study (n=7,740 unrelated subjects) and used Bayesian sparse linear mixed modeling to calculate genetic scores across 37,153 individuals with EMR data available. We discovered that a genetic predictor for white blood cell count was associated with anxiety disorder (OR=1.07, [1.04-1.10]) in this sample. These and other novel results from ongoing analyses will be presented.ELSI Initiative: Biobank research poses unique ethical challenges. The Center for Genetic Privacy and Identity in Community Settings (GetPreCiSe) at VUMC is an NIH Center of Excellence in ELSI Research (CEER) aimed at a) developing a more complete understanding of privacy concerns related to data sharing and b) addressing these concerns through policy recommendations. Early studies from the Precision Medicine Institute (PMI) and GetPreCiSe indicate that there is widespread confusion and concern about the meaning of “genomic privacy” in the context of biobanks. I will share the results of these early studies and discuss how they are shaping biobank research at VUMC and PMI.

Ethical Considerations for Mental Health Clinicians Working with Adolescents in the Digital Age.

Adolescents' use of digital technologies is constantly changing and significantly influences and reflects their mental health and development. Technology has entered the clinical space and raises new ethical dilemmas for mental health clinicians. After an update on this shifting landscape, including a brief review of important literature since 2014, this article will demonstrate how core ethical principles may be applied to clinical situations with patients, using vignettes for illustration. The vast majority of adolescents (95%) across all demographic groups can access smartphones (Anderson et al. 2018•). Technology use in mental health is also expanding, including a proliferation of "apps." While qualitative data from technology experts reports overall positive effects of technology (Anderson and Rainie 2018), concern about its potential negative impact on youth mental health remains high, and an association between technology use and depression is strong. Internet addiction, online sexual exploitation, and accessing illicit substances through the "dark net" pose additional clinical and legal concerns. In this context, clinicians have an ethical responsibility to engage in education and advocacy, to explore technology use with teen patients and to be sensitive to ethical issues that may arise clinically, including confidentiality, autonomy, beneficence/nonmaleficence, and legal considerations such as mandated reporting. New media and digital technologies pose unique ethical challenges to mental health clinicians working with adolescents. Clinicians need to stay abreast of current trends and controversies about technology and their potential impact on youth and engage in advocacy and psychoeducation appropriately. With individual patients, clinicians should watch for potential ethical dilemmas stemming from technology use and think them through, with consultation as needed, by applying longstanding core ethical principles.

Financial Incentives to Increase Uptake of Pediatric HIV Testing (FIT): study protocol for a randomised controlled trial in Kenya

IntroductionIndex case testing (ICT) to identify HIV-infected children is efficient but has suboptimal uptake. Financial incentives (FI) have overcome financial barriers in other populations by offsetting direct and indirect costs....

Ethical Issues in Research Involving Participants With Opioid Use Disorder

In the current epidemic of opioid use disorders, there is both a scientific and ethical imperative to develop effective medical and behavioral treatments for opioid addiction. Research in subject populations with active and ongoing drug addictions bring unique ethical considerations and challenges. Sponsors, researchers, and institutional review board (IRB) members should be familiar with these unique ethical and medical issues as they design, review, and conduct research planned for this population. Issues include those of informed consent and decision-making capacity of research participants, compensation for participation and concerns about undue inducement, forces that threaten the voluntary nature of research participation including the scarcity of available drug treatment programs, and ensuring that participants are aware of and understand risks that may continue after research participation such as increased risk of overdose after research-mandated drug abstinence. This manuscript discusses the current thinking on these issues.