Research Ethics in Medical Studies

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Questions and Answers

Which of the following components must be included in a research protocol?

  • Past research results
  • Aims and methods (correct)
  • Name of the institution
  • Date of publication

The welfare of animals used in research is not a significant consideration in medical research.

False (B)

What is the primary role of a research ethics committee?

To evaluate and approve the research protocol.

Free and informed consent is an essential component of respect for individual __________.

<p>autonomy</p> Signup and view all the answers

Which of the following factors must be considered before conducting medical research involving human participants?

<p>The importance of the objective compared to risks and burdens (B)</p> Signup and view all the answers

What is necessary before research involving human participants begins?

<p>Submission to a research ethics committee (C)</p> Signup and view all the answers

Researchers may engage in research with human participants without assessing the risks and burdens involved.

<p>False (B)</p> Signup and view all the answers

Match the following components with their descriptions:

<p>Aims = What the research intends to achieve Methods = The approach taken to conduct the research Risks = Potential negative impacts on participants Confidentiality = Protection of personal information</p> Signup and view all the answers

Participants who are capable of giving informed consent may not be enrolled unless they freely agree.

<p>True (A)</p> Signup and view all the answers

What should researchers do if the risks and burdens of the research outweigh the potential benefits?

<p>They must assess whether to continue, modify, or immediately stop the research.</p> Signup and view all the answers

Medical research should only include participants in situations of particular vulnerability if it is responsive to their health needs and priorities and they stand to benefit from the resulting ______.

<p>knowledge</p> Signup and view all the answers

What must the protocol describe in clinical trials regarding post-trial?

<p>Post-trial provisions.</p> Signup and view all the answers

What is one reason why individuals or groups might be excluded from medical research?

<p>To avoid additional risks and harms (D)</p> Signup and view all the answers

Match the following terms with their corresponding definitions:

<p>Vulnerability = Increased risk of being wronged or harmed in research Research waste = Inefficient or unnecessary research practices Health disparities = Distinctive health needs faced by certain groups Scientific rigor = Reliable and valid research designs</p> Signup and view all the answers

All medical research involving vulnerable populations must have a scientifically sound design.

<p>True (A)</p> Signup and view all the answers

What must be assessed when considering participants in vulnerable situations?

<p>The harms of exclusion versus the harms of inclusion.</p> Signup and view all the answers

What is the primary responsibility of physicians involved in medical research?

<p>To protect the life, health, and dignity of research participants (D)</p> Signup and view all the answers

The ethical principles in medical research can be ignored during public health emergencies.

<p>False (B)</p> Signup and view all the answers

What must be avoided in the design and conduct of medical research?

<p>Harm to the environment</p> Signup and view all the answers

Physicians combining research with medical care should involve patients only if it does not adversely affect their ______.

<p>health</p> Signup and view all the answers

Match the following terms with their descriptions:

<p>Autonomy = The right of participants to make informed decisions about their involvement in research Confidentiality = The assurance that personal information of participants is protected Environmental sustainability = Conducting research in a manner that minimizes environmental harm Underrepresented groups = Populations that have limited access to participate in medical research</p> Signup and view all the answers

Which of the following is NOT a responsibility of researchers in medical research?

<p>Reducing compensation for participants (D)</p> Signup and view all the answers

Research participants are entirely responsible for their own protection in medical studies.

<p>False (B)</p> Signup and view all the answers

What ethical principle must be maintained in medical research regardless of the situation?

<p>Protection of research participants</p> Signup and view all the answers

What was the primary motivation for developing the Nuremberg Code?

<p>To address unethical medical practices during World War II (B)</p> Signup and view all the answers

What must be disclosed to participants as part of informed consent regarding post-trial provisions?

<p>Specific information about post-trial provisions (D)</p> Signup and view all the answers

The Declaration of Helsinki is intended only for physicians conducting medical research.

<p>False (B)</p> Signup and view all the answers

Medical research involving human participants must be registered after the recruitment of the first participant.

<p>False (B)</p> Signup and view all the answers

What is the primary purpose of medical research involving human participants?

<p>To generate knowledge for understanding diseases and improving health.</p> Signup and view all the answers

What should physicians do before utilizing an unproven intervention in clinical practice?

<p>Seek expert advice, weigh risks, and obtain informed consent.</p> Signup and view all the answers

The health and well-being of my patient will be my first consideration, according to the WMA Declaration of __________.

<p>Geneva</p> Signup and view all the answers

Match the following ethical principles to their descriptions:

<p>Nuremberg Code = Set forth fundamental principles for ethical research Declaration of Helsinki = Statement of ethical principles for medical research WMA Declaration of Geneva = Affirms that patient health and well-being is a priority International Code of Medical Ethics = Commitment to patient health and well-being</p> Signup and view all the answers

Results of medical research must be _____, regardless of whether they are positive or negative.

<p>published</p> Signup and view all the answers

Match the following roles with their ethical obligations regarding research publication:

<p>Researchers = Make results publicly available Authors = Ensure accuracy of reports Publishers = Adhere to ethical guidelines Editors = Oversee dissemination of results</p> Signup and view all the answers

Which of the following is NOT a responsibility of physicians in medical research?

<p>Prioritize data collection over participant interests (C)</p> Signup and view all the answers

Medical research involving human participants must adhere to ethical standards.

<p>True (A)</p> Signup and view all the answers

What should be continuously evaluated through research even after being proven effective?

<p>Interventions and treatments</p> Signup and view all the answers

Under what conditions can research proceed without informed consent?

<p>If the research cannot be delayed and specific reasons have been stated (A)</p> Signup and view all the answers

A patient's refusal to participate in research can negatively impact their relationship with the physician.

<p>False (B)</p> Signup and view all the answers

What must physicians obtain from research participants regarding data and biological material?

<p>free and informed consent</p> Signup and view all the answers

Post-trial provisions must be arranged by _____ for participants who still need a beneficial intervention.

<p>sponsors and researchers</p> Signup and view all the answers

Which of the following is NOT an acceptable reason for using a placebo in research?

<p>The best proven intervention is ineffective (C)</p> Signup and view all the answers

Match the following terms with their correct description:

<p>Informed Consent = Agreement to participate after full disclosure Placebo = A substance with no therapeutic effect used in trials Research Ethics Committee = Group that supervises research compliance Post-Trial Provisions = Support for participants after the trial ends</p> Signup and view all the answers

Ongoing use of databases and biobanks does not require monitoring by a research ethics committee.

<p>False (B)</p> Signup and view all the answers

What must be established before a clinical trial regarding post-trial provisions?

<p>arrangements must be made by sponsors and researchers</p> Signup and view all the answers

Flashcards

Nuremberg Code

A set of ethical guidelines, developed after the inhumane medical practices during World War II, that establish fundamental principles for conducting research involving human subjects.

Declaration of Helsinki

An international document that outlines ethical principles for medical research involving human participants, including research using identifiable human material or data.

WMA Declaration of Helsinki audience

The document is primarily for physicians, but it emphasizes that these ethical standards should be followed by anyone involved in medical research.

Purpose of Medical Research

The primary goal of medical research involving humans is to generate knowledge that improves health and treatment, but these goals should never compromise the rights and well-being of participants.

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Ongoing Research Importance

Even established medical practices need constant reevaluation through research to ensure their safety, effectiveness, and efficiency.

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Ethical Standards in Human Research

Medical research involving humans must adhere to ethical standards that protect participants' health and rights.

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Patient Well-being and Rights

The Declaration of Helsinki emphasizes prioritizing the well-being of patients, even in research settings, and respecting their rights and autonomy.

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Physician's Oath

The Hippocratic oath, a cornerstone of medical ethics, binds physicians to prioritize the health and well-being of their patients.

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Ethical Principles in Emergencies

Ethical principles in the Declaration of Helsinki remain crucial even during public health emergencies, despite the need for new knowledge and interventions.

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Physician's Duty in Research

Physicians in medical research are responsible for participants' safety, health, dignity, privacy, and confidentiality. This responsibility cannot be transferred to participants, even with consent.

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Ethical & Legal Norms in Research

Medical research involving humans must adhere to ethical, legal, and regulatory norms of the origin and performance countries, as well as international standards.

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Environmental Considerations in Research

Medical research should be designed to minimize harm to the environment and aim for sustainability.

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Qualifications for Researchers

Only individuals with appropriate ethics, scientific education, training, and qualifications should conduct human research. It must be supervised by a competent and qualified physician or researcher.

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Inclusion in Research

Groups underrepresented in medical research should be given access to participate.

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Patient Involvement in Research

Physicians conducting research involving patients should ensure that participation is justified by its potential benefits and does not harm their health.

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Compensation for Research Harms

Compensation and treatment should be provided to participants who are harmed by research.

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Benefits vs. Risks in Research

In medical research, the potential benefits for participants and society should outweigh the risks involved.

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Risk Assessment in Research

Before involving humans in research, scientists must carefully assess the potential dangers and burdens participants might face.

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Risk Management in Research

Researchers must ensure they can manage and minimize the risks identified during the research process.

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Vulnerability in Research

Research involving vulnerable individuals, groups, or communities requires careful consideration to ensure their rights and wellbeing are protected.

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Inclusion vs. Exclusion of Vulnerable Groups

Scientists must weigh the potential harms of excluding vulnerable groups from research against the risks of inclusion. Excluding them could worsen existing health disparities.

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Responsive Research for Vulnerable Groups

Research with vulnerable groups should be designed to address their specific health needs and priorities, ensuring they benefit from the knowledge generated.

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Scientific Rigor in Research

Research should focus on generating reliable, valid, and valuable knowledge, ensuring efficiency and preventing wasted resources.

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Ethical Research Practices

Research involving human participants must be designed and executed with a focus on high-quality and ethical standards.

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Scientific Foundation of Research

Research must be grounded in established scientific methods, and rely on thorough literature review, relevant information, and adequate laboratory testing.

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Ethical Animal Research

Animal research is permitted if it is deemed necessary and conducted ethically, prioritising their well-being.

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What is a research protocol?

A detailed plan outlining the aims, methods, anticipated benefits, risks, and other important aspects of human research. It also covers ethical considerations and participant protections.

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What is a Research Ethics Committee?

This committee reviews and approves research protocols to ensure ethical conduct and safeguard participants' welfare.

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Protecting Privacy and Confidentiality

Protecting the privacy of participants and ensuring confidentiality of their personal information is crucial.

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Free and Informed Consent

Individuals must freely choose to participate in research, fully understanding the risks, benefits, and procedures involved.

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Who is involved in the informed consent process?

Family members or community representatives might be consulted for guidance, but individuals capable of consenting must give their own agreement.

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Post-Trial Provisions

In clinical trials, the protocol must include details about what happens to participants after the trial ends.

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Publication of Research Results

Researchers must publicly share the results of their research on human participants, regardless of whether the findings are positive, negative, or inconclusive. This ensures transparency and allows others to learn from the research.

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Research Registration

Before any human participants are recruited, medical research involving humans must be registered in a publicly accessible database. This helps track research and prevent duplication of effort.

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Research on Unproven Interventions

When a new treatment or intervention is used outside of a clinical trial to treat a patient, it should be documented and become the subject of future research to assess its safety and effectiveness. This process ensures responsible use of unproven therapies.

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Post-Trial Provisions in Consent

Participants in research must be fully informed of the potential risks, benefits, and procedures involved. This includes disclosure of any post-trial provisions, if applicable.

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Ethical Obligations in Publication

Researchers, authors, sponsors, editors, and publishers play important roles in ethical reporting of research. They must adhere to accepted guidelines, ensuring the accuracy, completeness, and timeliness of published results.

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Research without Informed Consent

Research can proceed without informed consent if a representative is unavailable, the research cannot be delayed, and the reasons for involving participants unable to consent are clearly stated.

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Transparency in Research

Researchers must inform participants about research-related aspects of their care. Refusal or withdrawal from research should not affect patient-physician relationships or care.

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Informed Consent for Biomaterial and Data

Researchers must obtain free and informed consent for collecting, processing, storing, and using biological material and identifiable data. The use of data and biobanks must comply with the WMA Declaration of Taipei.

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Testing Interventions

A new intervention should be tested against existing proven interventions unless there is no proven intervention, compelling scientific reasons, or no additional risk for participants receiving alternative treatments.

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Comparison with Existing Interventions

The benefits, risks, burdens, and effectiveness of a new intervention must be tested against those of the best proven intervention(s).

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Use of Placebo or No Intervention

Researchers may use placebo or no intervention in a trial if no proven intervention exists or if compelling scientific reasons justify it, and participants receiving alternatives don't face additional serious risks.

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Ethics Committee Approval for Biobanks

A research ethics committee must approve the establishment and monitor the ongoing use of databases and biobanks that collect and store biological material and identifiable data from research participants for multiple and indefinite uses.

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Study Notes

The Nuremberg Code

  • Developed in 1947, in response to unethical medical practices during World War II.
  • Sets forth fundamental principles for conducting ethical research involving human subjects.

Ten Principles of the Nuremberg Code

  • Participation must be completely voluntary, with informed consent as the cornerstone.
  • Subjects must understand the nature, duration, and purpose of the experiment, including potential risks and benefits.

2. Yielding Fruitful Results

  • Research should aim for significant societal benefits that cannot be obtained by other means.
  • Unnecessary experiments are ethically unjustifiable.

3. Prior Animal Studies

  • Experiments should be based on prior animal research and a solid understanding of the disease or problem
  • Ensuring potential risks to humans are minimized.

4. Avoiding Unnecessary Suffering

  • Experiments should avoid unnecessary physical or psychological suffering.
  • The subject's well-being is paramount.

5. No Expectation of Death or Disability

  • No experiment should be conducted where there is a prior reason to believe it will result in death or disabling injury
  • Except where researchers also serve as subjects, understanding and accepting the risks.

6. Risk Proportionality

  • The degree of risk should not exceed the humanitarian importance of the problem the experiment aims to solve.
  • If potential harm outweighs the anticipated benefits, the experiment is ethically indefensible.

7. Adequate Preparations

  • Proper precautions, including facilities, staff, and equipment, should be in place to minimize the risk of harm to subjects.

8. Qualified Staff

  • Experiments should be conducted by scientifically qualified persons, ensuring competence and care at all stages to protect participants' well-being.

9. Freedom to Withdraw

  • Participants should be allowed to withdraw from the experiment at any time if they feel unable to continue for any reason.

10. Obligation to Terminate

  • Researchers must be prepared to terminate the experiment if it becomes clear that continuation would endanger participants, prioritizing their welfare over research goals.

The Belmont Report

A. Respect for Persons

  • Emphases acknowledging the autonomy and dignity of individuals and protecting those with diminished autonomy, such as children and individuals with cognitive impairments.
  • Informed consent is central to this principle. Researchers must provide participants with clear, understandable information about the study, including its risks and benefits, so they can make an informed decision about their participation.

B. Beneficence

  • Requires researchers to maximize possible benefits while minimizing potential harm to participants.
  • Researchers should conduct thorough risk assessments, design studies that minimize potential harm, and ensure that the potential benefits of the research justify any risks involved.
  • This principle is not purely about doing good, but also about preventing harm.

C. Justice

  • Focuses on the fair distribution of the burdens and benefits of research.
  • Justice entails that no group should unfairly bear the risks of research (such as marginalized populations) and that benefits should be equitably available.
  • For example, if a new treatment is being developed, disadvantaged groups should not be disproportionately used as research subjects without potential benefits for them.

WMA Declaration of Helsinki

  • A statement of ethical principles for medical research involving human participants, including research using identifiable human material or data.

  • These principles should be upheld by all individuals, teams, and organizations involved in medical research to respect for and protection of all research participants, including both patients and healthy.

  • (Principles 1-10, follow the numbered order)

Individual, Group, and Community Vulnerability

  • Some individuals, groups and communities are vulnerable to research participation due to dynamic or fixed factors. They're at greater risk of harm, so their exclusion may perpetuate or exacerbate disparities.

Scientific Requirements and Research Protocols

  • Medical research involving human participants must have a scientifically sound and rigorous design
  • The research must conform to scientific principles and use reliable methods for producing valuable knowledge
  • Animal welfare must be respected when research involves animals.

Research Ethics Committees

  • Research protocols must be reviewed and approved by research ethics committees before initiating research
  • Transparency and independence must be maintained
  • Committees should have sufficient staff, resources, training and expertise to appropriately review protocols

Privacy and Confidentiality

  • Every precaution must be taken to protect the privacy and preserve the confidentiality of participants' personal information.
  • Free and informed consent is essential for respect of autonomy (the right to decide). Informed consent must be voluntary. Although family members and other representatives may be consulted, individuals must consent freely.

Risks, Burdens, and Benefits

  • In medical practice and in medical research, most interventions involve risks and burdens. Medical research involving human participants may only be conducted if the importance of the objective outweighs the risks and burdens to the research participants.

Use of Placebo

  • The benefits, risks, burdens, and effectiveness of a new intervention must be tested against the best proven intervention(s)
  • However, there are circumstances where using a placebo or no intervention may be acceptable
  • (Conditions where use of placebo, no intervention may be acceptable are listed)

Post-Trial Provisions

  • In advance of a trial, appropriate post-trial provisions must be arranged to address the needs of participants. These are the responsibility of sponsors, researchers, healthcare systems, and/or governments; these are subject to approval from a research ethics committee.

Research Registration, Publication, and Dissemination of Results

  • Medical research involving human participants must be registered in a publicly accessible database to ensure transparency before participant recruitment
  • Researchers have various ethical obligations when publishing and disseminating research results. The accounts of research on humans should be timely, comprehensive and accurate

Unproven Interventions in Clinical Practice

  • If an unproven intervention is used in place of a well established treatment, rigorous procedures must be followed, including obtaining informed consent, evaluating risks, and weighing benefits.

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