Module VIModule VI

Moral Reasoning in Moral Reasoning in Addiction PublishingAddiction Publishing

• Ethics of virtue and characterEthics of virtue and character

• Ethics of individual acts and rightsEthics of individual acts and rights

• Social ethics in service of the Social ethics in service of the commoncommongoodgood

Ethical Traditions ApplicableEthical Traditions Applicableto Publication Ethicsto Publication Ethics

Nuremberg Code: 1949 Nuremberg Code: 1949

Helsinki Declaration Helsinki Declaration 19641964

• The scientist’s obligations to individual The scientist’s obligations to individual subjects take precedence over any subjects take precedence over any obligations to the stateobligations to the state

• There are different moral implications There are different moral implications to therapeutic and non-therapeutic to therapeutic and non-therapeutic researchresearch

• Informed consent of the subject is Informed consent of the subject is morally essentialmorally essential

• Only qualified persons should conduct Only qualified persons should conduct researchresearch

General Ethical PrinciplesGeneral Ethical PrinciplesRespect for personsRespect for persons Autonomy and self-determinationAutonomy and self-determination

Meaningful informed and voluntary consentMeaningful informed and voluntary consent

BeneficenceBeneficence Maximizing benefits by promoting the well-Maximizing benefits by promoting the well-being of being of subjects and societysubjects and society

Non-maleficenceNon-maleficenceMinimizing harmMinimizing harm

JusticeJustice Persons bearing burden of research should Persons bearing burden of research should

receive appropriate benefits: subjectsreceive appropriate benefits: subjects

should not be placed at risk merely becauseshould not be placed at risk merely because

of convenient access, their compromised of convenient access, their compromised position, or ability to be manipulated.position, or ability to be manipulated.

Ethical principles and Guidelines for the Protection of Human Subjects of Ethical principles and Guidelines for the Protection of Human Subjects of Research (Belmont Report 1979)Research (Belmont Report 1979)

1 Checklist for Analysis of Critical 1 Checklist for Analysis of Critical Incidents Incidents

Incident/situation Incident/situation

1 Whose interests are involved; who can be harmed?1 Whose interests are involved; who can be harmed?

Which interests, if any, are in conflict?Which interests, if any, are in conflict?

interests and interests and vulnerabilitiesvulnerabilities

significantsignificant moderatemoderate minimal / minimal / nonenone

yourselfyourself

co-workersco-workers

institutioninstitution

professional professional fieldfield

science / science / societysociety

2 2 Application of Universal Application of Universal ValuesValues

____ Autonomy (freedom over one's own destiny)____ Autonomy (freedom over one's own destiny)

____ Beneficence (do good; help others)____ Beneficence (do good; help others)

____ Non-maleficence (don't hurt anyone)____ Non-maleficence (don't hurt anyone)

____ Justice (be fair; distribute by merit)____ Justice (be fair; distribute by merit)

____ Obedience (obey legal and ethically permissible directives)____ Obedience (obey legal and ethically permissible directives)

____ Conscientious refusal (disobey illegal or unethical directives)____ Conscientious refusal (disobey illegal or unethical directives)

____ Gratitude (pass good along to others)____ Gratitude (pass good along to others)

____ Competence (be knowledgeable and skilled)____ Competence (be knowledgeable and skilled)

____ Stewardship (use resources wisely)____ Stewardship (use resources wisely)

____ Honesty and candor (tell the truth)____ Honesty and candor (tell the truth)

____ Fidelity (keep your promises)____ Fidelity (keep your promises)

____ Loyalty (don't abandon)____ Loyalty (don't abandon)

____ Diligence (work hard)____ Diligence (work hard)

____ Discretion (respect confidence and privacy)____ Discretion (respect confidence and privacy)

____ Self-improvement (be the best that you can be)____ Self-improvement (be the best that you can be)

____ Restitution (make amends to persons injured)____ Restitution (make amends to persons injured)

____ Self-interest (protect yourself)____ Self-interest (protect yourself)

____ Other culture-specific values____ Other culture-specific values

3 What Laws, Standards, Policies, 3 What Laws, Standards, Policies, Practice Guidelines, Historical Practice Guidelines, Historical Practices should Guide us in this Practices should Guide us in this Situation?Situation?

Copyright lawsCopyright laws Review Board/Ethics Committee standardsReview Board/Ethics Committee standards Professional policy documentsProfessional policy documents

Toward a Moral CompassToward a Moral Compass

Patients/subjectsPatients/subjects– Do no harmDo no harm– Benefit the participantBenefit the participant

The scientific communityThe scientific community– TransparencyTransparency– HonestyHonesty– AccuracyAccuracy

Procedures to Prevent or Resolve Procedures to Prevent or Resolve Moral DilemmasMoral Dilemmas

• Ethical reviewEthical review• Risk-benefit analysisRisk-benefit analysis• Informed consentInformed consent• Peer reviewPeer review• Uniform requirements for Uniform requirements for

attributing authorship creditsattributing authorship credits• Professional ethics: ISAJE Professional ethics: ISAJE

GuidelinesGuidelines

Risk/Benefit AnalysisRisk/Benefit Analysis

• Age, gender, socioeconomic statusAge, gender, socioeconomic status• Current or prior substance abuse problemCurrent or prior substance abuse problem• Family history and other indicators of riskFamily history and other indicators of risk• Medical and psychological statusMedical and psychological status• Availability of backup servicesAvailability of backup services• Provisions for de-briefing of subjectsProvisions for de-briefing of subjects• Formal and informal coercion to Formal and informal coercion to

participateparticipate

Responsible Performance of Responsible Performance of ResearchResearch

• Choice of research questionChoice of research question• Research design to avoid Research design to avoid

subjectivity and minimize biassubjectivity and minimize bias• Unbiased collection of dataUnbiased collection of data• Data management, storage, Data management, storage,

retrieval and ownershipretrieval and ownership• Analysis of dataAnalysis of data

Reporting of FindingsReporting of Findings

• Review of literature and citation Review of literature and citation proceduresprocedures

• Crediting previous workCrediting previous work• Interpretation of findingsInterpretation of findings• Sharing research materials, data and Sharing research materials, data and

informationinformation• Duplicate and fragmented publicationDuplicate and fragmented publication• Avoidance of premature reporting or Avoidance of premature reporting or

publishingpublishing Reporting in the public mediaReporting in the public media