evidence base discussion response 3

Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”

References:

• Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.

Words Limits

• Response posts: Minimum 100 words excluding references.

Discussion 1

Clinical research and medicine are two different entities. Physicians and nurses have a duty to their patients, in the here and now, to provide the best medical care they can. Researchers, on the other hand, focus on advancing scientific knowledge in the interest of future patients (Jansen, 2018). As a result, researchers run the risk of not providing their research subjects with the best possible medical care or advice. This is due to the simple fact that doing so may not serve the ultimate goal of the research project. This fact is glaringly obvious in the Tuskegee Syphilis Project. And though there are laws, regulations, and procedures in place now that are meant to protect research subjects, there is always an underlying concern that an ethical principle will be, whether deliberate or inadvertently, violated during a research study.

The Tuskegee Syphilis Project seemed to begin innocently enough as a study meant to look at the rates of venereal diseases in the rural south. By 1932, though, this study had changed from a study that may have worked towards breaking the cycle of poverty and disease to a study that watched individuals’ progress through the stages of untreated syphilis. Most individuals participated in this study because they believed they were actually receiving treatment for “bad blood”. Also, their families were going to be provided money for their burials (Fourtner, Fourtner, & Herreid, 2000). And for a very poor community, this would be hard to turn down. Also, many of the participants had never been treated by a physician prior to this study. For many people, even now, physicians can carry a certain amount of authority. When you add a nurse who gained the trust of the men, it is not surprising that these men continued to stay with the study.

The ethical principle violated in the Tuskegee Syphilis Project was informed consent. Many of the men involved in the study were either unaware of the true nature of the project or unaware they were study subjects at all. Also, the Tuskegee Project violated the men’s right to fair treatment and protection from harm by withholding treatment (LoBiondo & Haber, 2014). Researchers have an obligation to obtain informed consent from all participants in research trials. Informed consent follows the principle of respect and an individual’s right to autonomous decisions (Jansen, 2018). Participants should know the purpose, benefits, and risks of a study. If these men would have had all the information available to them, they would have been able to make an informed decision in regards to participating or leaving the study.

Though one would hope that these types of research atrocities are a thing of the past, we should all assume that they are not. By acknowledging this possibility, we can hope to better recognize it if and when it happens again. Researchers often justify their studies by the prospective results they will obtain for the benefit of the future even at the cost of the present. And though there are policies, procedures, and different organizations in place that research studies need to be evaluated against, there is always the chance that something may slip through. We should never complacently believe these types of things will never happen again. We should, instead, be ever vigilant for the sake of our patients.

References

Fourtner, A.W., Fourtner, C.R., & Herreid. (2000). Bad blood: A case study of the Tuskegee syphilis

project. National Center for Case Study Teaching in Science. University of New York: Buffalo, NY.

Jansen, L. A. (2018). Taking respect seriously: Clinical research and the demands of informed

consent. Journal of Medicine And Philosophy, 43(3), 342-360. doi: 10.1093/jmp/jhy006

LoBiondo-Wood, G., & Haber, J. (2014). Nursing research: Methods and critical appraisal for

evidence- based practice. Elsevier Health Sciences: St. Louis, MO.

Discussion 2

This week’s discussion is on the Tuskegee Syphilis Project. A clinical study of African American men in Alabama with untreated syphilis. I will be examining this topic from an ethical perspective. I will be including my views on the issues on adequate treatment, informed consent and the autonomy of the test subjects.

In the clinical study of untreated syphilis of these African American men they were from a very rural area, some would say a poor area. These men were not likely to seek out medical treatment for this problem. When this diseased population was discovered they were subjected to a series of clinical trials. It was done under the watchful eye of some very prestigious facilitators and physicians. Health research has a great ethical responsibility according to LoBiondo-Wood and Haber (2014).Majority of workers involved in this study were African American themselves. The main nurse involved was African American herself. It seemed it had all the makings of a legitimate study. Turns out that wasn’t the case.

These men were not offered adequate treatment. Although there were side effects of these medication to be cautious of, the powers that be declined to offer these various forms of treatments. The option for penicillin was even passed on once it was proven therapeutic. This is outrageous. The moral code of conduct by these researchers left these men defenseless according to Paul and Brookes (2015). In my practice as a nurse I cannot imagine having the cure available and not providing it. This clinical study is completely unethical. It only gets worse. Majority of these men, if any, had no clue they were involved in a study. There cannot be any way to go back and fix this situation. Being said, these men had no informed consent. In my role as a nurse if I don’t have a signed consent, especially for blood, that results in automatic grounds for termination. The complete lack of autonomy in this situation is heartbreaking. I have a very humanistic heart. To think that these men had no way of stopping their involvement in this situation is just terrible. I realize that there was knowledge gained by this study but the biggest take away is the unethical treatment of these humans. This has sparked great Research in ethics and fascinating reports have come from this.

In conclusion, the main objective is to provide autonomy to human beings involved in research. The Tuskegee Study was extremely unethical. This has sparked a change in the way research is overseen. This heartbreaking situation resulted in these vulnerable men treated similarly to lab rats by leaving them untreated. These men were completely unaware of what exactly they were involved in. Race, regarding racism, may have played a larger role than is conveyed.

References

LoBiondo-Wood, G., Haber, J. (2014). Nursing Research Methods and Critical Appraisal for Evidence-Based Practice. St. Louis, Missouri: Elsevier Inc.

Paul, C., & Brookes, B. (2015). The Rationalization of Unethical Research: Revisionist Accounts of the Tuskegee Syphilis Study and the New Zealand “Unfortunate Experiment”. American Journal Of Public Health, 105(10), e12-e19. doi:10.2105/AJPH.2015.302720