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  • Print publication year: 2010
  • Online publication date: March 2012

27 - Ethics in anesthesiology research using human subjects

from 4 - Research and publication

Summary

This chapter considers an ethical framework to guide decision making to explore frequently encountered obstacles. It offers practical suggestions to enhance care for patients dying in the intensive care unit (ICU). To this effect, the chapter presents a case study of an 88-year-old woman with a history of diabetes, stable coronary artery disease, and hypertension, where there was consensus to switch the focus to palliation. Four basic ethical principles should guide end-of-life decision-making in the ICU: respect for the patient's autonomy; the duty of beneficence; the duty of nonmaleficence; and the obligation to ensure just distribution of care. End-of-life care, particularly making decisions to withhold or withdraw life support, is a fundamental component of critical care practice. Appropriate end-of-life decision-making hinges on the intensivist's understanding of key ethical principles. Careful, deliberate, and empathic explanations and negotiation usually lead to choices acceptable to both family members and the medical team.

References

1* Committee on Bioethics (1999). Guidelines on the Ethics of Clinical Research in Anesthesia. Toronto: Canadian Anesthesiologists’ Society.
2* King, N.M.P. and Churchill, L. (2008). Clinical research and the physician-patient relationship: the dual roles of physician and researcher. In The Cambridge Textbook of Bioethics. Singer, P.A. and Viens, A.M., eds. Cambridge, UK: Cambridge University Press, pp. 214–21.
3* Lemmens, T. and Luther, L. (2008). Financial conflicts of interest in medical research. In The Cambridge Textbook of Bioethics. Singer, P.A. and Viens, A.M., eds. Cambridge, UK: Cambridge University Press, pp. 222–30.
4* World Medical Association. (2008) Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. Washington: World Medical Association.
5* Ashcroft, R.A. and Viens, A.M. Clinical Trials. In The Cambridge Textbook of Bioethics. Singer, P.A. and Viens, A.M., eds. Cambridge, UK: Cambridge University Press, pp. 201–6.

Further reading

Beauhamp, T.L. and Childress, J.F. (2001). Principles of Biomedical Ethics, 5th edn. New York, NY:Oxford University Press
CIOMS (2002). International Ethical Guidelines for Biomedical Research Involving Human Subjects. Geneva: Council for International Organisations of Medical Sciences.
Faden, R. and Beachamp, T.L. (1986). A History and Theory of Informed Consent. New York, NY:Oxford University Press.
Freedman, B. (1987). Scientific value and validity as ethical requirements for research: a proposed explanation. IRB, Rev Hum Subj Res 17, 7–10.
Maltby, J.R. and Eagle, C. J. (1993). Informed consent for clinical anaesthesia research. Can J Anaesth, 40, 891–6.
Levine, R.J. (1988). Ethics and Regulation of Clinical Research. New Haven, CT: Yale University Press.
Slowther, A. and Kleinman, I. (2008). Confidentiality. In: SingerP.A. and Viens, A.M., eds. The Cambridge Textbook of Bioethics. Cambridge, UK: Cambridge University Press. pp. 43–8.
Sykes, K. and Bunker, J., eds. (2007). Anaesthesia and the Practice of Medicine: Historical Perspectives. London: Royal Society of Medicine Press.