Archive for the 'Scientist/layperson relations' category

Are ethical principles optional?

At White Coat Underground, PalMD ponders what to make of members of the same professional community with divergent views of the ethical principles that ought to guide them:

As I thought a bit more about the doctor who wrote the letter to the editor we discussed yesterday, I wondered how two similarly-trained doctors (he and I) could come to such different conclusions about ethical behavior.

The generally agreed upon set of medical ethics we work with has developed over centuries. Patient confidentiality, for example, was demanded by Hippocrates of Kos. But many of the medical ethics we work with are fairly modern developments that reflect the thinking of our surrounding society. The changing weight of patient dignity and autonomy vs. physician paternalism is such an example.

The very fact that our views (individually and collectively) or what is or is not ethical change over time is important to notice. The folks who believe there are "moral facts" in the world for us to discover might account for this in terms of improvements in our ability to perceive such moral facts (or maybe an improvement in our willingness to look for them). Myself, I'm not sure you need to be committed to the existence of objective moral facts to grant that the project of sharing a world with others may change in important and interesting ways as our societies do. And, I don't think we can rule out the possibility that in some respects, earlier generations may have been jerks, and that we can do better ethically, or at least try to.

"Justice" makes its official entry into the list of essential ethical principles that need to guide research with human subjects (whether biomedical or not) in the Belmont Report, which was convened to respond to the Tuskegee syphilis experiment. That 30 year long study was notable for how unequally risks of the research and the benefits from the knowledge it produced were distributed, and the public outcry when the study was exposed in the newspapers (while it was still ongoing) made it clear that the behavior of the researchers was ethically abhorrent in the eyes of a significant segment of the American public.

In Belmont, it's worth noting, justice is one of three guiding principles (the other two being beneficence and respect for persons). The authors of Belmont acknowledge that the tensions that sometimes arise between these three principles can make it difficult to work out the best thing (ethically speaking) to do. However, attention to these three principles can help us rule certain courses of action right out (because they wouldn't fit with any of the principles, or only kind of fit with one while violating the other two, etc.). It's not a matter of throwing one of the three principles overboard when the tensions arise, but rather of finding a way to do the best you ca by each of them.

On the matter of someone who might say, "I don't believe justice is an essential ethical principle, so I'm going to opt out of being guided by it," here's my take on things:

Ethics do not begin and end with our personal commitments. Ethics are all about sharing a world with other people whose interests and needs may be quite different from our own. Ethical principles are meant to help up remember that other people's interests and needs have value, too, and that we can't just trash them because it's inconvenient for us to take those interests and needs seriously. In other words, in ethics IT IS NEVER ALL ABOUT YOU.

This is not to say that there aren't struggles (especially in a pluralistic society) about the extent of our ethical obligations to others. But you can't opt out without opting out of that society.

And here's where we get to the researcher or physician (my expertise is in the ethical standards guiding communities of researchers, but PalMD notes that the current position of medical ethics now embraces justice as a guiding principle). He's free to say, "I'll have no truck with justice," if he is prepared as well to opt out of membership in that professional community. Alternatively, he can stay and try to make a persuasive case to his professional community that justice ought not to be one of the community's shared ethical values; if he changes enough minds, so goes the community. (This could have implications for how willing the broader society is to tolerate this professional community, but that's a separable issue.*)

But, he cannot claim to be part of the community while simultaneously making a unilateral decision that one of the community's explicitly stated shared values does not apply to him.

I think Pal nicely captures why physicians (among others) should take the community standards seriously:

Why should physician’s adhere to any code of ethics? Can’t we just each rely on ourselves as individuals to do what’s right?

As doctors we are given extraordinary privileges and responsibilities. Physicians have always recognized that this demands high standards of behavior. The way we act professionally must take into account not just what we each believe, but what our patients and our society believes. Ethics are easy if we all have the same values. Ethics get hard when we don’t share beliefs. And when we don’t share beliefs, we must at the very least remember our core principles, those of helping our patients, and not causing them harm; of granting them autonomy and privacy; of treating them with basic human dignity.

Even physicians have to share a world with the rest of us. Our ethics, whether as members of professional communities or or society at large, are a framework to help us share that world. Maybe you can make a case for opting out of an ethical principle you don't care for if you are the supreme leader of your world, or have a world of your very own with no world-mates. Otherwise, it behooves you to figure out how to play well with others, even if sometimes that's hard..
_____
*While it's a separable issue, it's worth noting, as I have before, that the codes of conduct, ethical principles, and such adopted by professional communities exist in part to reassure the broader public that these professional communities mean the public well and don't plan to prey on them.

Share

4 responses so far

Data release, ethics, and professional survival.

In recent days, there have been signs on the horizon of an impending blogwar. Prof-like Substance fired the first volley:

[A]lmost all major genomics centers are going to a zero-embargo data release policy. Essentially, once the sequencing is done and the annotation has been run, the data is on the web in a searchable and downloadable format.

Yikes.

How many other fields put their data directly on the web before those who produced it have the opportunity to analyze it? Now, obviously no one is going to yank a genome paper right out from under the group working on it, but what about comparative studies? What about searching out specific genes for multi-gene phylogenetics? Where is the line for what is permissible to use before the genome is published? How much of a grace period do people get with data that has gone public, but that they* paid for?

-----
*Obviously we are talking about grant-funded projects, so the money is tax payer money not any one person’s. Nevertheless, someone came up with the idea and got it funded, so there is some ownership there.

Then, Mike the Mad Biologist fired off this reply:

Several of the large centers, including the one I work at, are funded by NIAID to sequence microorganisms related to human health and disease (analogous programs for human biology are supported by NHGRI). There's a reason why NIH is hard-assed about data release:

Funding agencies learned this the hard way, as too many early sequencing centers resembled 'genomic roach motels': DNA checks in, but sequence doesn't check out.

The funding agencies' mission is to improve human health (or some other laudable goal), not to improve someone's tenure package. This might seem harsh unless we remember how many of these center-based genome projects are funded. The investigator's grant is not paying for the sequencing. In the case of NIAID, there is a white paper process. Before NIAID will approve the project, several goals have to be met in the white paper (Note: while I'm discussing NIAID, other agencies have a similar process, if different scientific objectives).

Obviously, the organism and collection of strains to be sequenced have to be relevant to human health. But the project also must have significant community input. NIAID absolutely does not want this to be an end-run around R01 grants. Consequently, these sequencing projects should not be a project that belongs to a single lab, and which lacks involvement by others in the subdiscipline ("this looks like an R01" is a pejorative). It also has to provide a community resource. In other words, data from a successful project should be used rapidly by other groups: that's the whole point (otherwise, write an R01 proposal). The white paper should also contain a general description of the analysis goals of the project (and, ideally, who in the collaborative group will address them). If you get 'scooped', that's, in part, a project planning issue.

NIAID, along with other agencies and institutes, is pushing hard for rapid public release. Why does NIAID get to call the shots? Because it's their money.

Which brings me to the issue of 'whose' genomes these are. The answer is very simple: NIH's (and by extension, the American people's). As I mentioned above, NIH doesn't care about your tenure package, or your dissertation (given that many dissertations and research programs are funded in part or in their entirely by NIH and other agencies, they're already being generous†). What they want is high-quality data that are accessible to as many researchers as possible as quickly as possible. To put this (very) bluntly, medically important data should not be held hostage by career notions. That is the ethical position.

Prof-like substance hurled back a hefty latex pillow of a rejoinder:

People feel like anything that is public is free to use, and maybe they should. But how would you feel as the researcher who assembled a group of researchers from the community, put a proposal together, drummed up support from the community outside of your research team, produced and purified the sample to be sequenced (which is not exactly just using a Sigma kit in a LOT of cases), dealt with the administration issues that crop up along the way, pushed the project through (another aspect woefully under appreciated) the center, got your research community together once they data were in hand to make sense of it all and herded the cats to get the paper together? Would you feel some ownership, even if it was public dollars that funded the project?

Now what if you submitted the manuscript and then opened your copy of Science and saw the major finding that you centered the genome paper around has been plucked out by another group and publish in isolation? Would you say, “well, the data’s publicly available, what’s unscrupulous about using it?” ...

[L]et’s couch this in the reality of the changing technology. If your choice is to have the sequencing done for free, but risk losing it right off the machine, OR to do it with your own funds (>$40,000) and have exclusive right to it until the paper is published, what are you going to choose? You can draw the line regarding big and small centers or projects all you want, but it is becoming increasingly fuzzy.

This is all to get back to my point that if major sequencing centers want to stay ahead of the curve, they have to have policies that are going to encourage, not discourage, investigators to use them.

It's fair to say that I don't know from genomics. However, I think the ethical landscape of this disagreement bears closer examination.

Continue Reading »

Share

11 responses so far

Professionalism, pragmatism, and the Hippocratic Oath.

In a recent post about a study of plagiarism in the personal statements of applicants for medical residency programs, the issue of professionalism reared its head. The authors of that study identified plagiarism in these application essays as a breach of professionalism, and one likely to be a harbinger of more such breaches as the applicant’s medical career progressed. Moreover, the authors noted that:

increasing public scrutiny of physicians’ ethical behavior is likely to put pressure on training programs to enforce strict rules of conduct, beginning with the application process.

I think it’s worth taking a closer look at what “professionalism” encompasses and at why it would be important to a professional community (like the professional community of physicians). To do this, let’s go way back to an era where physicians were working very hard to distinguish themselves from some of the other thinkers and purveyors of services in the public square – the time when the physicians known as the Hippocratics were flourishing in ancient Greece.

These physicians were working to make medicine a more scientific practice. They sought not just ways to heal, but an understanding of why these treatments were effective (and of how the bodies they were treating worked). But another big part of what the Hippocratics were trying to do involved establishing standards to professionalize their healing practices – and trying to establish a public reputation that would leave the public with a good opinion of learned medicine. After all, they weren’t necessarily pursuing medical knowledge for its own sake, but because they wanted to use it to help patients (and to make a living from providing these services). However, getting patients depended on being judged trustworthy by the people who might need treatment.

Professionalism, in other words, had to do not only with the relationship between members of the professional community but also with the relationship between that professional community and the larger society in which it was embedded.

The physicians in this group we’re calling the Hippocratics left a number of writings, including a statement of their responsibilities called “The Oath”. It’s worth noting that the Hippocratic corpus contains a diversity of works that reflect some significant differences of opinion among the physicians in this community – including some works (on abortion and surgery, for example) that seem to contradict some of the specific claims of “The Oath”. Still, “The Oath” gives us pretty good insight into the kind of concerns that would motivate a community of practitioners who were trying to professionalize.

We’re going to look at “The Oath” in its entirety, with my commentary interspersed. I’m using the translation of by J. Chadwick in Hippocratic Writings, edited by G.E.R. Lloyd.

I swear by Apollo the healer, by Aesculapius, by Health and all the powers of healing, and call to witness all the gods and goddesses that I may keep this Oath and Promise to the best of my ability and judgment.

In other words, it’s a serious oath.

I will pay the same respect to my master in the Science as to my parents and share my life with him and pay all my debts to him. I will regard his sons as my brothers and teach them the Science, if they desire to learn it, without fee or contract.

This is a recognition of the physician’s debt to professional community, those who taught him. It’s also a recognition of his duty to educate next generation of the profession.

I will hand on precepts, lectures and all other learning to my sons, to those of my master and to those pupils duly apprenticed and sworn, and to none other.

This part is all about keeping trade secrets secret. The assumption was that learned medicine involved knowledge that should not be shared with everyone, especially because a lot of people wouldn’t have the wisdom or intelligence or good character to use it appropriately. Also, given that these physicians wanted to be able to earn a living from their healing practices, they needed to keep something of a monopoly on this knowledge.

I will use my power to help the sick to the best of my ability and judgment; I will abstain from harming or wronging any man by it.

Here’s the recognition of the physician’s duty to his patients, the well-known commitment to do no harm. Obviously, this commitment is in the patients’ interests, but it’s also tied to the reputation of the professional community. Maintaining good stats, as it were, by not doing any harm should be expected to raise the community’s opinion of the profession of learned medicine.

I will not give a fatal draught to anyone if I am asked, nor will I suggest any such thing. Neither will I give a woman means to procure an abortion.

These two sentences forbid the physician’s participation in euthanasia or abortion. Note, however, that other writings in the Hippocratic corpus indicate that physicians in this tradition did participate in such procedures. Maybe this was a matter of local variations in what the physicians (and the public they served) found acceptable. Maybe there was a healthy debate among the Hippocratics about these practices.

I will be chaste and religious in my life and in my practice.

This part basically calls upon the physician to conduct himself as a good person. After all, the reputation of whole profession would be connected, at least in the public’s view, to the reputation of individual practitioners.

I will not cut, even for the stone, but I will leave such procedures to the practitioners of that craft.

Cutting was the turf of surgeons, not physicians. Here, too, there are other writings in the Hippocratic corpus that indicate that physicians in this tradition did some surgery. However, before the germ theory of disease or the discovery of antibiotics, you might imagine that performing surgery could lead to a lot of complications, running afoul of the precept to do no harm. Again, that was going to hurt the professional community’s stats, so it seemed reasonable just to leave it to the surgeons and let them worry about maintaining their own reputation.

Whenever I go into a house, I will go to help the sick and never with the intention of doing harm or injury.

This reads as an awareness of the physician’s power and of the responsibilities that come with it. If patients are trusting the physician and giving him this privileged access, for the good of the professional community he had better live up to that trust.

I will not abuse my position to indulge in sexual contacts with the bodies of women or men, whether they be freemen or slaves.

This is more of the same. Having privileged access means you have the opportunity to abuse it, but that kind of abuse could tarnish the reputation of the whole profession, even of physicians whose conduct met the highest standards of integrity.

Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one.

To modern eyes, this part might suggest a commitment to maintain patient privacy. It’s more likely, however, that this was another admonition to protect the trade secrets of the professional community.

If, therefore, I observe this Oath and do not violate it, may I prosper both in my life and in my profession, earning good repute among all men for all time. If I transgress and forswear this Oath, may my lot be otherwise.

“Swear to God and hope to die, stick a needle in my eye!” Did we mention that it’s a serious oath?

The main thing I think is worth noticing here is the extent to which professionalism is driven by a need for the professional community to build good relations with the larger society – the source of their clients. Pick any modern code of conduct from a professional society and you will see the emphasis on duties to those clients, and to the larger public those clients inhabit, but this emphasis is at least as important for the professional community as for the people their profession is meant to serve. The code describes the conduct that members should exhibit to earn the trust of the public, without which they won’t get to practice their profession – or, at any rate, they might not be viewed as having special skills worth paying for, or as being the kind of people who could be trusted not to use those special skills against you.

Professionalism is not idealistic, then, but extremely pragmatic.

Share

4 responses so far

Premeds, chemistry professors, pedagogy, and economics.

In comments on my earlier post in which I mused on the wisdom of having chemistry and physics courses serve to weed out an excess of premed students, Peter R. wrote:

1) There would be far fewer chemistry professors (albeit happier) if pre-med students did not take chemistry. Chemistry majors are always, and have always been, the minority of students in general and organic chemistry.

2) The idea that chemistry is a “weed-out” course is misleading, because it is not the chemistry instructor’s job to choose who goes to medical school. Our job is to determine how well our students learn chemistry. It was not the chemistry faculty that made chemistry a requirement, although they certainly benefit from it. The students “weed” themselves out.

These are observations worth discussing, not least because I think discussing them will help us become more aware of some of our assumptions about how colleges and universities ought to work.

Let's start with the second observation first -- that chemistry professors are really only charged with evaluating student performance in the context of the course requirements for the particular chemistry course they're teaching.

I agree that this is what the job description is. You teach the class, you assess the students (with problem sets, exams, lab reports, and the like), and you assign the appropriate grade. As I've discussed before, there are differing philosophies on what it means to assign the appropriate grade -- whether the grade is supposed to reflect something like the student's distance from the Platonic form of "getting" the material, or whether instead it should reflect how many standard deviations the student has scored from the mean for the class, whether that mean is relatively high or relatively low on an absolute scale. But your garden variety chemistry professor shouldn't also be tasked with determining which students are likely to succeed in medical school or to make good physicians* because your garden variety chemistry professor have very little basis for making that determination, having never been a physician or even a medical student.

However, there are a couple of things that complicate this picture.

One is that I cannot help but feel that some chemistry professors end up adopting the grading-on-a-strict-bell-curve model because of the relatively large number of premeds compared to chemistry majors enrolled in the classes they teach. The assumption is that the chemistry majors will make up most of the As and Bs on that curve, while the teeming masses of premeds will make up most of the Cs, Ds, and Fs. (Premeds who end up making As are sometimes actively recruited to consider majoring in chemistry and perhaps even pursuing graduate studies in chemistry rather than medicine>0

This in itself wouldn't necessarily be worrisome -- maybe it would just be a reasonable prediction about the range of competency and motivation in the student population. But sometimes the prediction that premeds won't learn organic chemistry (for example) as well as the chemistry majors seems to manifest itself in a pedagogy that puts less onus on the professor to teach the material and more onus on the students to learn it their own selves.

At which point, the professor in question is pretty much only determining how well the student learn chemistry, but not doing the teaching that you might have assumed was part of the job.

On the other hand, however, I think it's an open question how medical schools would respond if chemistry professors suddenly got very serious about teaching all of their students -- premeds included -- in such a way that the vast majority of them learned the course material, and learned it very well. The anecdotal reports I heard (while I was teaching in an MCAT preparation course to help pay the bills between graduate) suggested that a school where more premed students were getting As and Bs in chemistry was judged "easier" by medical school admission committees, while one where fewer premed students got As and Bs in chemistry was judged "more challenging". If that's true, that would seem to penalize students with professors who take pedagogy more seriously than the bell curve.

And that makes it seem an awful lot like medical school admission really are pushing the weeding out onto chemistry professors.

Myself, I think that the ability to master the basics of general chemistry, or organic chemistry, or physical chemistry, is not the sort of thing that is (or ought to be) perfectly congruent with one's major.** If taught well, the underlying principles of chemistry ought to be intelligible to almost any intelligent person (or at least, to more than not). Assuming up front that a whole class of students one is teaching are constitutionally unable to learn the material is giving up at the very start. And regardless of the instrumental use that medical schools might get out of this stance, I think it rather undermines one's teaching duty to one's home department.

Now, onto the first observation, that there would be fewer chemistry professors if chemistry classes (whether "weeders" or not) were not required for admission to medical school.***

The situation is such that chemistry departments often exist to offer "service courses" to support pre-professional programs. In many universities (including my own), philosophy departments also justify their existence by their service courses (in our case, the large number of courses we offer that fulfill various general education requirements). It's nice to be able to point to a curriculum that needs to be taught, not just by the lights of your own discipline (which, obviously, thinks that core material within that discipline is terribly important), but also by the lights of other disciplines -- especially if those disciplines have multitudes of customers students. This kind of demand means that, when you get the staffing to teach the coursework that is being demanded, you also get colleagues who are doing interesting research, who can add breadth to the courses you offer to your majors, and with whom it is productive (and fun) for you to interact.

But, especially in science departments, and especially at research-focused universities, this increased population of professors also leads to an increased demand for research funding, equipment, and lab space, and an increased demand for graduate students and technicians to keep the professors' research projects moving forward. (Those graduate students are also in demand to do the grading in all those well-populated premed courses.)

Down the road, of course, this will mean more people with Ph.D.s competing for those professorial posts**** (which only exist in the numbers they do on account of the demand generated premeds required to take the courses those departments' professors teach) competing for the posts there are.

This is not a huge incentive for chemistry professors (or chemistry graduate students) to question the common wisdom that general chemistry and organic chemistry (and maybe even biochemistry and physical chemistry) are absolutely essential preparation for medical school.

Perversely, the supply and demand equation also seems to act against reexamining the quality of the teaching in those required premed chemistry courses. After all, if you turn out premeds who are too smart, what are the chances that the senior faculty will die off at a reasonable rate and open up some jobs for the Ph.D. chemists they've trained?

_____
*Despite this, I will confess that the slogan "Save a life: fail a premed!" gained a certain traction with the chemistry TAs in my graduate program.

**If I didn't already think that majors and the subjects that one is good at were separable, my friend the fine arts major who took math courses for fun would have pushed me in that direction.

***The claim that these chemistry professors would be happier depends, I think, on the current state of the transaction between premeds and chemistry professors, in which the students only care instrumentally for what the professors are offering and the professors have already decided that most of those premeds won't be able to learn the material, or that they are diluting the contact between chemistry professors and chemistry majors, or what have you. I'm not saying that the claim is false, but like most counterfactual claims, how we evaluate it depends a lot on our hunches about what other moving parts in the situation might have relevant effects.

****And before that, for postdoctoral appointments.

Share

7 responses so far

Americans for Medical Progress names two Hayre Fellows in Public Outreach.

Today Americans for Medical Progress has announced two recipients for academic year 2010-2011 of the Michael D. Hayre Fellowship in Public Outreach, designed to inspire and motivate the next generation of research advocates. This year, I'm especially wowed by their project.

From the AMP press release:
Continue Reading »

Share

No responses yet

Standing up for what we believe.

Lab_mouse_copy.jpg

(Click to embiggen)
Tomorrow, April 8, 2010, Pro-Test for Science will be holding its second rally in Los Angeles in support of humanely conducted, ethical animal research and the people who conduct it. Their first rally last April drew approximately 700 people to the streets to support the scientific research that offers hope to patients (both human and veterinary) and their families.
Speaking of Research has details on tomorrow's rally:

Continue Reading »

Share

19 responses so far

Common ground and deeply held differences: a reply to Bruins for Animals.

In a post last month, I noted that not all (maybe even not many) supporters of animal rights are violent extremists, and that Bruins for Animals is a group committed to the animal rights position that was happy to take a public stand against the use of violence and intimidation to further the cause of animal liberation.
On Wednesday, Kristy Anderson (the co-founder of Bruins for Animals), Ashley Smith (the president), and Jill Ryther (the group's advisor) posted a critical response to my post. In the spirit of continuing dialogue, I'd like to respond to that response.
They write:

AR activists can rightly accept praise and credit for encouraging the two sides to come together in what was an unprecedented public and civil dialogue. However, one glaring and rather twisted irony too often overlooked is the fact that those very same participants who speak against aggressive campaigns against the animal experimentation industry and who are quick to praise AR advocates' stance on nonviolence are themselves engaged in (or are supporters of) violence and intimidation towards sentient beings on a daily basis.

Continue Reading »

Share

23 responses so far

#scio10 aftermath: Continuing thoughts on what civil engagement could mean, online or offline.

Back in January, at ScienceOnline2010, Sheril Kirshenbaum, Dr. Isis, and I led a session called "Online Civility and Its (Muppethugging) Discontents". Shortly after the session, I posted my first thoughts on how it went and on the lessons I was trying to take away from it.
Almost two months later, I'm ready to say some more about the session and the issues I think it raised.

Continue Reading »

Share

2 responses so far

Some modest proposals for animal rights supporters looking to make their case without resorting to harassment, intimidation, or violence.

I take it that a good number of animal rights supporters feel that their position is philosophically well-grounded, intuitively appealing, and compatible with the flourishing of humans as well as of non-human animals.
As such, I would argue that animal rights supporters can, and should, advance their position without resorting to tactics that depend on harassment, intimidation, or violence. (At least some animal rights supporters agree.) Especially since the hope is to win the hearts and minds of the larger public to the cause of animal rights, supporters of this position might want to hold on to the moral high ground.
How can they do this? Here are four options that leap to mind:

Continue Reading »

Share

26 responses so far

Our cause is good, so our tactics don't need to be?

Earlier this week, I related a situation I found alarming in which a scientist and his children were targeted for harassment because he dared to express the view that research with animals plays an important role in answering scientific questions that matter to scientists and to the public. I was not alone in decrying these tactics. At least one animal rights group also condemned them.
Given that the post was pretty clearly directed at the question of tactics, I am frankly puzzled by this comment from Douglas Watts:

When I see mainstream "science" commit itself to a program which phases out vivisection by date certain, this post would have credibility. Without such a pledge and plan, you are basically saying that scientists are separate from the rest of society and should not be held to the standards the rest of society must live up to. In doing so, you are making the anti-vivisectionists point for them: scientists are unwilling and unable to clean up their own house.

If I'm understanding it, the logical structure of what Douglas Watts is claiming here is something like this:

Continue Reading »

Share

27 responses so far

« Newer posts Older posts »