Posted: March 3rd, 2022

Class 1 Replies

Instructions: Post 2 replies of at least 250 words. Each reply must incorporate at least 1 scholarly citation in APA format. Each reply should include integration of Biblical Worldview with supporting scripture. Any sources cited must have been published within the last five years. Acceptable sources include the textbook, the Bible, peer- reviewed journal articles.

Classmate 1: Commonalities in Unethical Practices

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The Havasupai, American Indians, and less developed countries all shared similar treatment throughout the articles. The major commonality is that all three groups were vulnerable populations who were taken advantage of. This is a highly unethical practice in biomedical research. Researchers may assume that vulnerable populations are easy targets because of low socioeconomic status, education level, or lack of medical care. Another commonality is that ethical codes were twisted to create outcomes that researchers wanted. For example, researchers were dishonest with all subjects regarding the risk to benefit ratio, and the data being collected. All three studies also showed that research has consequences that can impact large groups of people for generations.

Violated Ethical Principles

Safe and quality care was not given to the patients in the in any of these three examples. The Code of Ethics for nurses states to do no harm (nonmaleficence). The ethical dilemmas came when patient rights were violated in the name of biomedical research. Factors such as neglecting informed consent and withholding treatment for research purposes provided ethical issues. Vulnerable populations were also impacted and not taken into consideration. For example, in the Tuskegee study, African American sharecroppers were chosen to be studied. The men were mostly illiterate, and also already sick with Syphilis, making participants more vulnerable. Participants were promised benefits promised such as free medical care, free transportation to the clinic, free meals, and free burial insurance (CDC, 2020). Although light was shed on these issues in the Tuskegee study, research on American Indians led to the same damage. Risks outweighed the benefits for American Indians who were subject to being studied for years.

Lessons Learned

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One major lesson learned is that vulnerable populations need to be protected, regarding both health and legal rights. Another lesson learned is that subjects should be able to ask questions and receive honest answers. In the research community, several concerns could be addressed through these ethical issues. One concern is that although a small group of subjects may be studied, snowball effects can be seen in subjects’ families and communities for years to come. Negative health outcomes are another lesson to be learned for both subjects and their families.

Suggested Guidance, Practices or Policies

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Policies should be continuously created and enforced to ensure that subject rights are not being violated. Vulnerable populations should be studied with extra care and legal assistance. IRBs should be maintained with strong parameters and boundaries. Researchers should continue to be educated on new study methods and procedures to ensure that safe studies can be conducted.

Christian Worldview

From a Biblical Worldview, the Havasupai, American Indian and less developed country studies should not have been conducted in the first place. As the Bible says in Romans, “No one who loves others will harm them. So, love is all that the law demands (English Standard Version Bible, 2001). From a Christian standpoint, love should be given to everyone, despite race, gender, economic status, or age. Honesty and kindness should also be given to anyone willing to participate in research.

Classmate 2: As Christian nurses, we are called to adopt ethical practice in our daily work. The Bible educates us to treat others as we would want to be treated, and to respect human life. Matthew 7:12 states, “so whatever you wish others would do to you, do also to them, for this is the Law and the Prophets” (English Standard Version Bible, 2001). As we adopt ethical practice in clinical work, we must also adhere to ethical practice within nursing research to uphold to the standard that the Bible sets for us in respecting others.

There are five basic rules of ethics, autonomy, beneficence, nonmaleficence and justice and all medical research should uphold these principles (Artal & Rubenfeld, 2017). In the articles, many of these ethical principles were violated. As is the case with the involuntarily sterilization of Native Americans and the genetic testing of the Havasupai people in Arizona, the right to autonomy was violated because the choice was not given to them to proceed with the research. In both cases, informed consent was not obtained prior to the start of the study. In many unethical research practices, the necessity to obtain informed consent was blatantly disregarded (Artal & Rubenfeld, 2017). In the case of the heinous trichoma treatment and Tuskegee syphilis study, nonmaleficence was violated because the people involved in the study were knowingly harmed, including disfiguration, suffering, and death. In the case of the involuntarily research on Native Americans, the argument could be made that justice was also violated as there were minimal repercussions for the heinous acts of the doctors and researchers involved. Beneficence was also grossly violated in all cases because there was no real benefit to the participants, and the interventions caused much more harm than good. Beneficence means that researchers should work diligently to maximize the benefit of the intervention while also decreasing risk of harm to the participants (Heale, 2017).

The policy of informed consent would help decrease some of these errors from occurring again. Having stringent policies about informed consent and the definition of ethical practice are critical to mitigating any potential unethical research. The National Institute of Justice outlined 7 rights of participants to be maintained during research, which includes voluntary participation with informed consent, autonomy, right to end participation, right to integrity, appropriate risk benefit ratio, safety, and access to research information (Artal & Rubenfeld, 2017). Having legal implications for unethical practice can also hold researchers accountable for any unjust acts against participants.

In many of the cases discussed in the article, there was blatant disregard for human life and these minority groups were treated as “less than”. As Christians, the Bible teaches against this idea that anyone is less than anyone else. The Bible teaches us to treat every individual with the utmost respect for their life. Jesus set the example for this with the work and care he gave to the poor and those disregarded by society. As Christian nurses, we must lead by example to speak up if we notice anything unethical, and to make sure we are well-versed in ethical principles as we continue through our daily work.