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CTSS109 Ethics And Professional Conduct

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CTSS109 Ethics And Professional Conduct

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CTSS109 Ethics And Professional Conduct

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Course Code: CTSS109
University: Centennial College is not sponsored or endorsed by this college or university

Country: Canada


Ethical Case Study – Research and Medicine Collide in Haiti
Background: (New York Times, 6 June 1999) – The impoverished patients who step from dirt sidewalks into the modern AIDS research clinic run by Cornell Medical College in Port-au-Prince, Haiti, are offered a seemingly simple arrangement.
     “We would like to test your blood because you live in an area where AIDS may be common.” The English version of the clinic’s consent form reads. “We will provide you with medicine if you fall sick and cannot afford such care.”
     But the transaction is not as straightforward as it sounds. Many Haitians who visit the clinic are at once patients and subjects of United States-financed medical research, and circumstances that are bad for their health are sometimes best for research results.
     That conflict is especially true in Cornell’s most tantalizing research in Haiti, a study of sex partners, only one of whom is infected with the AIDS virus. Researchers, seeking clues to developing a vaccine, study the blood of both partners, particularly the uninfected ones who continue to be exposed to the virus through unprotected sex. They are trying to find out whether some people have natural protections against infection with the AIDS virus that could be replaced with a vaccine.
     The Haitians are ideal research subjects, largely because they are not receiving the kind of care now standard in the world’s developed countries. Condom use is low in Haiti, for cultural and other reasons. Anti-retroviral drugs that are successful at suppressing the virus are unavailable except to the very wealthy and are not included in Cornell’s promise to provide medicine.
     Nearly 20 years after Cornell opened the clinic, it provides some of the best AIDS treatment available in a country devastated by the epidemic, fighting the myriad illnesses that result from AIDS. But that is a lower standard of care than patients receive routinely at American institutions, including the hospital affiliated with Cornell in New York City.
     If the research were done in the United States, experts agree, the physicians would be obligated to prescribe the anti-retrovirals and deliver the most effective possible counseling against unprotected sex.
     The ethical questions posed by Cornell’s work among Haiti’s poor are at the heart of a global debate about AIDS research that is roiling international health organizations from Geneva to Thailand, challenging ethics formulations established decades ago.
     “It’s really like a Faustian bargain,” said Marc Fleisher, a member of the committee at Cornell that reviews research on humans. “It’s like, since we’re making this a better place, we’re going to exploit it in a way we could never get away with in the United States,” said Mr. Fleisher, the outside member on a board made up mostly of university employees who are doctors.
     Cornell doctors defended the couples’ study as vitally important and stressed that its subjects receive the same counseling about the dangers of AIDS and the same care as other patients at the Haitian clinic.
     United States standards for research on humans were strongly influenced by outrage over the 40-year Tuskegee syphilis study conducted in Macon County, Alabama by the U.S. Public Health Service (USPHS) in 1932, which misled impoverished black subjects for years while tracking their disease, and withheld treatment even after penicillin became widely available by the early 1950’s as the preferred treatment for syphilis. In fact, on several occasions, the USPHS actually sought to prevent treatment. Moreover, a committee at the federally operated Center for Disease Control decided in 1969 that the study should be continued. Only in 1972, when accounts of the study first appeared in the national press, did the Department of Health, Education and Welfare halt the experiment. At that time, seventy-four of the original 400 syphilitic men and 200 uninfected men that served as controls were still alive; at least twenty-eight, but perhaps more than 100, had died directly from advanced syphilitic lesions.
     Today’s subjects are not to be pressured to participate in research, according to Federal regulations. They are to be fully informed about the research’s purposes and risks. They must receive the best available therapy for their illnesses and be told about any findings relevant to their health.
     In theory, the same rules apply to federally financed studies overseas.  But an examination of 15 years of records related to the Haiti couples research shows that it has received scant scrutiny from Government officials in Washington. And the Government’s rules barely address the moral ambiguities of AIDS research in indigent countries.
     Dr. Warren D. Johnson, the chief of international medicine and infectious diseases at Cornell, called the couples study “a very high priority,” though he said it had been temporarily suspended while the university concentrated on other research in Haiti. “This is the crucial group in the world – couples – that’s where the war is to be fought,” he said.
     At least 97 couples have been enrolled in the blood study since 1991, records show, but Dr. Johnson said only 30 are still being followed. The study will be expanded to new couples early next year, he said, and coordinated with AIDS vaccine trials, which are expected to start in Haiti this fall using similar couples as subjects.
     Cornell’s clinic in Haiti offers strong inducements to subjects. It is the only center in the country providing free screening and treatment for H.I.V., venereal disease, and tuberculosis, a common complication of AIDS. The thousands who flock to it are too poor to buy food, let alone the simple medicines and vitamins that serve as “a powerful incentive for study participation,” in the words of one Cornell grant report.
     The head of the clinic, Dr. Jean William Pape, is a Haiti native and Cornell professor who has studied AIDS in Haiti for two decades. Dr. Pape, who trained at Cornell, defended the treatment of research subjects in the couples’ study, saying they benefited from the same counseling and free condoms available to everyone who visits the clinic.
     Dr. Pape said that offering the life-saving drugs to the handful of research subjects would be an unethical lure to participate. Treating all H.I.V.-infected citizens, he said, would cost 10 times Haiti’s health budget.
     If the research on couples succeeds, he said, it could help lead to a vaccine against AIDS. “You have to take into account people who mean well for their country and not impose on them things that you feel are good for Western ideals,” he said.
     The Haitians were valuable for another reason. Unlike AIDS patients in the United States and Europe, they were not receiving the anti-retroviral drugs that proved effective in halting the disease’s progress.
     The lack of those drugs “may allow identification of novel findings not easily studied in the U.S.A.,” Dr. John L. Ho, a Cornell immunologist, wrote in an application for Federal funds. In 1995, the Federal Government awarded Cornell an extra $60,000.00 to expand this part of the Haitian couples’ study.
     Ethical standards for Federally financed studies require that patients be told why researchers want to study them. But the written consent form approved at Cornell and read aloud in Creole to each potential subject does not mention that the study focuses on couples in which only one sexual partner has tested positive for H.I.V.
     The form tells subjects their blood is being tested because “you live in an area where AIDS may be common.” It promises all patients that H.I.V. test results will be kept confidential.
     After reviewing clinic materials, Marie Saint Cyr, a native of Haiti who now directs an AIDS program for women in Harlem, said there was a “clear conflict of interest” between the desire to collect information from research subjects and the obligation to effectively warn patients at risk.
     “If you know somebody is positive and is having sex with a partner who is negative, you have a life and death situation in front of you,” she said. “You have to do individualized counseling to really tap into what those people value in life, to confront them with the reality of H.I.V. and AIDS. This in no way addresses those serious things.
Ethical Case
After carefully reading the Ethical Case Study- Research and Medicine Collide in Haiti several times, thoughtfully answer the following questions:

What would a Utilitarian tell you about the ethics of the Cornell research study in Haiti?  In answering the question, evaluate and discuss the strengths and weaknesses of the utilitarian’s argument as to whether or not the Cornell research study in Haiti was ethical.
What would a Kantian tell you about the ethics of the Cornell research study in Haiti?    In answering the question, evaluate and discuss the strengths and weaknesses of the Kantian’s argument as to whether or not the Cornell research study in Haiti was ethical.
What are Your thoughts based on your personal code of ethics? Was the Cornell research study in Haiti ethical? Evaluate and discuss your reasoning as to why the Cornell research in Haiti agreed with or violated your personal code of ethics.
Since you have been studying Virtue, Utilitarian and Kantian ethics, has your personal code of ethics been challenged? Are there strong points in Virtue, Utilitarian and Kantian ethics that you would adopt into your personal code of ethics? If so or if not, discuss what changes you would adopt and how you and others would benefit from the change(s).


Utilitarian ethics
Utilitarianism believe that an action is deemed right of the action is said to be promoting happiness or wrong if the intent of an action is a product that contradicts happiness. It does not necessarily mean the happiness of the doer of the action but all the people who might be affected by the action. In support to utilitarian, the research on couples at Cornell Medical College contradicts the spirit of utilitarianism since the research does not disclose to the research subjects that they are more interested in couples where one partners HIV positive (Mandal Ponnambath & Parija, 2016).
This is attested by the concept of utilitarian which suggests that the theory relies on some intrinsic value where all other values are to be derived from the intrinsic value (Ives & Bekessy, 2015). However, the weakness of utilitarian arguments is that all other values are based on the intrinsic value and the end goal of the research at Cornell is determined to find a vaccine or cure for HIV and AIDS. It implies that the test subjects receive treatment and medicine as benefits during the study and their action to contribute in the research is considered as a good gesture which is meant to benefit many people (Metzger, 2016).
Kantian ethics
Kantian ethics stems from the work of Immanuel Kant and is considered as the universal theory that informs the principles of ethics. It postulates that the wrongness and rightness of an action does not necessarily depend on the consequences rather whether the actions fulfil some form of duty (Baron, 2018). In this regard, Cornell research study in Haiti is considered as moral duty to find the vaccine or cure of HIV and AIDS. The strengths of Kantian ethics provides the basis to create a distinction and inclination which is beneficial to other people. Therefore, since the research is aimed at finding better approach to the virus then it is justified.
Kantian ethics makes justice impartial because one cannot promote happiness with an action that undermines the happiness of another person. Further, humans are given an intrinsic worth, respects and dignity which confirms that humans have similar rights (Formosa, 2017). Weaknesses attributed form Kantian school if thought is that no rules are to be followed when two duties are in conflict such as the duty to protect the patient and the duty to find a better approach in dealing with HIV and AIDS. More so, Kantian do not provide allowance for compassion and sympathy.
Personal Thoughts
Cornell research study in Haiti violated the personal code of ethics. This is because each and every human being has a right to decisions that affect their lives. Subjecting people to a research without clearly enabling them to understand the purpose of the research is misguided. Just like the Tuskgee research, it is ethically wrong to involve an individual in a matter of life and death without their consent. The reason why the research is conducted in Haiti is because such a research would receive huge backlash from the public and government if such information came out. Moreover, the research is ethically wrong because senior individuals at the clinic suggest that they are offering the test subjects with numerous benefits which alludes to a win-win situation when in reality a persons’ life is at stake. There are different approaches that the research can use in the lab as opposed to continue with the research that goes against the ethical guidelines of carrying out a research study.
From my studies on Virtue, Utilitarian and Kantian ethics, my personal code of ethics has been challenged since there exist different philosophical approaches of justifying whether an action is right or wrong (Van Hooft, 2014).  In essence, all the school of thoughts agree or disagree to an extent depending on the action in discussion. There are several strong points in virtue that inclines me to believe in its principles. Among the reasons is that virtue is a moral habit that enables an individual to maintain their values. The values are closely associated with the moral standards of living.
 For instance, both the clinicians and subjects have same rights but the values of the test subjects are undermined. If the clinicians upheld virtue with which guides their values, then the research process would not have proceeded under the same circumstances. However, there are other factors that influence virtue and go beyond moral standards. In such a case, the overall goal of the research study supersedes the human rights and virtues of the clinicians. The changes that I would adopt with respect to the research at Cornell clinic is uphold virtue and inform the test subjects all about the research and work with those willing to participate since it would benefit those who are negative and would not want to be under a study is  inconsistent with guidelines of medical research.
Baron, M. W. (2018). Kantian ethics almost without apology. Cornell University Press.
Formosa, P. (2017). Kantian ethics, dignity and perfection. Cambridge University Press.
Ives, C. D., & Bekessy, S. A. (2015). The ethics of offsetting nature. Frontiers in Ecology and the Environment, 13(10), 568-573.
Mandal, J., Ponnambath, D. K., & Parija, S. C. (2016). Utilitarian and deontological ethics in medicine. Tropical parasitology, 6(1), 5.
Metzger, J. A. (2016). Humanism, Illness, and Elective Death: A Case Study in Utilitarian Ethics. Essays in the Philosophy of Humanism, 24(1).
Van Hooft, S. (2014). Understanding virtue ethics. Routledge. 

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