Liberalism, authority, and bioethics commissions.

Bioethicists working on national ethics commissions frequently think of themselves as advisors to the government, but distance themselves from any claims to actual authority. Governments however may find it beneficial to appear to defer to the authority of these commissions when designing laws and policies, and might appoint such commissions for exactly this reason. Where does the authority for setting laws and policies come from? This question is best answered from within a normative political philosophy. This paper explains the locus of moral authority as understood within one family of normative political theories--liberal political theories--and argues that most major "liberal" commentators have understood both the source and scope of ethics commissions' authority in a manner at odds with liberalism, rightly interpreted. The author argues that reexamining the implications of liberalism for bioethics commissions would mean changing what are considered valid criticisms of such commissions and also changing the content of national bioethics commission mandates. The author concludes that bioethicists who participate in such commissions ought to carefully examine their own views about the normative limits of governmental authority because such limits have important implications for the contribution that bioethicists can legitimately make to government commissions.

Diferencias entre comités de ética en investigación públicos y privados en ciudad de México: un estudio cualitativo / Diferenças entre comitês de ética públicos ou privados em pesquisa na Cidade de México: um estudo cualitativo / Differences between public and private research ethics committees in México City: a qualitative study

Describir problemas que enfrentan los Comités de Ética en Investigación (CEI) en la Ciudad de México. Método. Estudio cualitativo con muestreo intencional, grupos de discusión y teoría fundamentada con CEI de sector público y privado en instituciones de salud de la Ciudad de México. Resultados. Se detectaron importantes diferencias entre los CEI públicos y privados. Principalmente en carga de trabajo y prioridades de investigación. Los protocolos aprobados por CEI públicos son asumidos por la institución como un todo. Enfrentan cada caso como equipo de salud. Los CEI privados dirigen la responsabilidad de los protocolos al investigador principal que es quien la asume individualmente. Los CEI privados tienen una agenda centrada en los reportes de efectos adversos y la legalidad del proceso, mientras que los públicos en general se abocan además a la relevancia de la investigación para los pacientes. Ambos reciben pago por la revisión. Ambos coinciden en priorizar la ética de los protocolos en beneficio del paciente. Ambos están al tanto de que la industria farmacéutica les marca sus prioridades de investigación. Los CEI públicos abarcan principalmente investigación epidemiológica. Los CEI privados, esencialmente terapéutica.

Describe the problems facing research ethics committees (RECs) in Mexico City. Methodo. A qualitative study with purposive sampling, discussion groups and grounded theory focused on public and private sector RECs in health institutions in Mexico City. Results. Significant differences were detected between public and private RECs, mainly with respect to their workload and research priorities. The protocols approved by public RECs are assumed by the institution as whole. They address each case as health team. In contrast, the private RECs place accountability for the protocols on the chief researcher, who assumes that responsibility individually. The private RECs have an agenda focused on reports of adverse effects and the legality of the process, while the public RECs also generally afford consideration to the relevance of research for patients. Both are paid for the review. Both agree on prioritizing the ethics of protocols for the benefit of the patient. Both are aware the pharmaceutical industry has its research priorities. The public RECs deal mainly with epidemiological research, while the private RECs are concerned essentially with therapeutic research.

Objetivo. Descrever os problemas enfrentados pelos Comitês de Ética em Pesquisa (CEI) na Cidade do México. Metodo. Estudo qualitativo com amostragem intencional, grupos focais e teoria fundamentada, realizado nos CEI dos setores público e privado em instituições de saúde na Cidade do México. Resultados. Foram detectadas diferenças significativas entre os CEIs públicos e os privados. Principalmente nas prioridades de trabalho e pesquisa. A instituição se encarrega dos protocolos aprovados pelos CEIs públicos como um todo. Cada caso é estudado como equipe de saúde. Os CEIs privados delegam a responsabilidade dos protocolos ao investigador principal, que os assume individualmente. Estes CEIs têm uma agenda baseada nos relatórios de efeitos adversos e da legalidade do processo, enquanto os públicos procuram, ademais, a relevância da pesquisa para os pacientes. Ambos recebem pagos pela revisão. Ambos concordam em priorizar a ética dos protocolos em benefício do paciente. Ambos estão conscientes de que a indústria farmacêutica determina as suas prioridades de pesquisa. Os CEIs públicos dedicam-se à investigação epidemiológica; os privados, à terapêutica.

Asignación de recursos en salud en Chile: consideraciones éticas en la toma de decisión / Ethical considerations about decision making in health care source allocation in Chile

Background: The inclusion of ethical aspects in the world health care reform is currently being discussed. Aim: To analyze the ethical component of health care decision making in Chile. Material and methods: A qualitative analysis of interviews with 4 health service directors, 4 public hospital directors and 1 sub director. Inquiries to 16 public hospital ethics committees, about importance of ethical components in decision making, role of ethics committees in financial issues and the feasibility of incorporation explicit ethical considerations in decision making. Results: There is an absence of explicit ethical criteria in decision making. There is little participation of directors in these issues and lack of information. Although ethical aspects are considered relevant, they are not taken into account. Ethics committees are mostly dedicated to evaluate research protocols. The community is not mentioned as a relevant actor in decision making about resource allocation. Conclusions: Health service directors and all health care personnel should be trained in bioethics. These aspects should be incorporated to their daily work

Handling of scientific dishonesty in the Nordic countries. National Committees on Scientific Dishonesty in the Nordic Countries.

Despite a widely recognised need, most countries still have no coherent system to deal with scientific misconduct. Committees have been established by the national medical research councils in Denmark (1992), Norway (1994), and Sweden (1997), and by the Ministry of Education in Finland (1994), to deal with scientific misconduct--ie, to initiate preventive measures, to investigate alleged cases, or both. Each committee includes both scientifically and legally qualified members. The employing institutions are responsible for possible sanctions or punishments. So far, 47 cases have been accepted for investigation, the majority (25) being Danish. Disputed authorship was the most frequent reason for investigation. Junior researchers made complaints in only three of the investigated cases. Investigations have been completed in 37 cases; in nine cases, dishonesty was revealed--two of them were related to the same researchers. Cooperation between the four Nordic committees has shown close agreement on specific issues and cases, despite minor differences in definitions, organisation, and procedures.

The Medical Ethics Committee: dinosaur or phoenix?

Just when managed care is forcing providers to confront new ethical dilemmas, ethics committees are preoccupied with formal compliance programs. A proposal for renewal.

The future of healthcare ethics committees.

Ethics committees are fairly common in healthcare institutions in the United States. Comprised of a multidisciplinary membership, including physicians, their functions within institutions are generally threefold: policy recommendation, ethics education and case consultation. The number of such committees will grow as a result of "Patient Rights" standards established by the Joint Commission on Accreditation of Healthcare Organizations (1992 Manual). The author projects and discusses five areas of development and change in the future of healthcare ethics committees. These five areas are: 1) renewed efforts to educate healthcare professionals, 2) cooperation and collaboration among ethics committees, 3) networking with community-based ethics groups, 4) clearer delineation of responsibilities and limitations, and 5) continuous quality improvement. The ability of ethics committees to address successfully these areas of change will determine their future usefulness.

Today's ethics committees face varied issues. A CHA survey reveals committees' functions, authority, and structure.

In a survey of Catholic Health Association member hospitals, 92 percent indicated they have formal ethics committees at their institutions. Sixty-two percent said their ethics committees were formed between 1983 and 1989. The survey found that current ethics committees are still committed to their traditional roles--education, policy development, and case review--but the education is directed to more diverse audiences than in the past. Support for medical and nursing staffs may be emerging as another possible function of ethics committees. The issues that precipitated the formation of institutional ethics committees have become more complex. In particular, questions involving the appropriate use of technology, the renewed awareness of patients' rights, changing relationships among healthcare providers, and conflicting social values have continued to require the intervention of ethics committees. However, the frequency with which respondents said their committees provide case consultations seems lower than it should be if committees were used to their full advantage. The institutional ethics committee can play a part in enlarging the current healthcare reform debate and promoting moral values. It can address such important questions as, Should the well-being of individuals take precedence over the well-being of communities?