The international treaties can be used to guide nursing practice. Much like examining the research coming from the World Health Organization as well as the national organizations for comprehensive evidence, we can examine and implement international ethical standards for more inclusive guidelines. In this assignment research on human subjects was emphasized. These include a collaboration of a variety of views and national standards, not just the guidelines based on US principles.
While exploring the international treaties, I came across information on vulnerable populations. My previous post on prisoners led me to focus on prisoners as an example of a vulnerable population in research. This is a contained population who will likely “consent” to be subjects. Because they are imprisoned and have no other opportunities, they are vulnerable to coercion, manipulation and abuse by the researcher and institution. The Helsinki agreement listed below discusses the use of vulnerable populations as subjects.
Medical research is subject to ethical standards that promote respect for all human beings and protect their health and rights. Some research populations are vulnerable and need special protection. The particular needs of the economically and medically disadvantaged must be recognized. Special attention is also required for those who cannot give or refuse consent for themselves, for those who may be subject to giving consent under duress, for those who will not benefit personally from the research and for those for whom the research is combined with care (World Medical Association, 2004).The documented history of US experimentation on prisoners is long.
Postwar American research grew rapidly as prisoners became the backbone of a lucrative system predicated on utilitarian interests Uneducated and financially desperate prisoners "volunteered" for medical experiments that ranged from tropical and sexually transmitted diseases to polio, cancer, and chemical warfare (Hornblum, 1997).Some of the more known prisoner experiments were the radiation studies. These experiments were the last of decades of brutal experimentation. Fortunately this led to the establishment of principles of experimentation on prisoners (Hornblum, 1997). While there have been positive changes in the direction of prisoner research, the international treaties and ethical codes may not be acknowledged by the US.
The treatment of prisoners who do not fall into the categories described in Article 4 has led to the current controversy regarding the Bush Administration's interpretation of "unlawful combatants". The phrase "unlawful combatants", although not appearing in the Convention itself, has been used since at least the 1940s to describe prisoners not subject to the protections of the Convention. Because many of the guerillas do not display a "fixed distinctive sign recognisable at a distance", they are traditionally not entitled to the protections of the Geneva Convention (Wikipedia, 2006).The aforementioned statement refers to the prisoners being held in Guantanamo Bay, Cuba. The US seems to be unaware of international requirements in this situation. Instead of awareness they are redefining what prisoners are. The prisoners in Guantanamo are in an unclear legal spot. They do not possess the same rights as prisoners or prisoners of war because they are not associated with a state. If they were considered POWs then according to the Nuremberg principles and Geneva convention, they would prohibited as subjects (Moreno, 2003).
This alone, makes them prime subjects for research and exploitation. Additionally, these prisoners are not popular people. They are construed as terrorists making significant public objection unlikely.
The United States has manipulated laws and codes. Testimony by American medical experts at Nuremberg allowed American physicians and researchers to believe that the Nuremberg Code was directed only at Nazi scientists (Hornblum, 1997). In this case the US is not acknowledging the Nuremberg principles. Similarly, in Guantanamo, the US does not consider the captives prisoners of war thus, forfeiting their human rights. Instead of prisoners of war, they are referred to as enemy combatants. Redefining what the prisoners are creates detainees absent of any rights, including the right to informed consent as research subjects.
Research Investigators should be aware of the ethical, legal and regulatory requirements for research on human subjects in their own countries as well as applicable international requirements. No national ethical, legal or regulatory requirement should be allowed to reduce or eliminate any of the protections for human subjects set forth in this Declaration (World Medical Association,2004).The Moreno (2003) article discusses the ethics of interviewing prisoners in Guantanamo Bay to learn about the psychology of terrorists. The benefit of these interviews follow a utilitarian view that they can benefit society. By knowing how the terrorist operates, perhaps terrorism can be decreased. At face value, these may be somewhat benign psychological interviews. Given the United States’ lengthy record of damaging experiments on prisoners and prisoners of war and its disregard for rules and treaties such as the Geneva convention, it is difficult to believe that more invasive experiments are not happening in Guantanimo Bay.
Considering the circumstances of the detainees' incarceration not only direct ethical concerns about respect for persons, but also the indirect results of this behavioral research raise questions. It seems unlikely that these so-called interviews are benign chats over a pot of tea (Moreno, 2003).As nurses we serve people at risk in all situations. The prisoners of war can be our patients. Our commitment is to the patient regardless of their circumstances. For Clinical Nurse Leaders (CNL), social justice is one of the more important values. According to the American Association of Colleges of Nursing (2004), “Altruism, accountability, human dignity, integrity and social justice are the guiding values of the nursing profession. For the CNL, however, the value of social justice is particularly significant because it directly addresses disparities in health and health care.” We have a moral obligation to not only recognize human rights abuses but also change the system that allows these abuses.
References
American Association of Colleges of Nursing (2004). Working paper on the Role of the Clinical Nurse Leader. Retrieved May 10, 2006 from http://www.aacn.nche.edu/CNL/cnlpubs.htmHornblum, A.M. (1997). They were cheap and available: prisoners as research subjects in twentieth century America. British Medical Journal, 315(7120):1437-41. Retrieved May 9, 2006 from http://bmj.bmjjournals.com/cgi/content/full/315/7120/1437
Moreno, J.D. (2003). Detainee Ethics: Terrorists as Research Subjects. The American Journal of Bioethics, 3(4):W32-W33. Retrieved May 9, 2006 from http://www.bioethics.net/journal/j_articles.php?aid=70
Wikipedia (2006). Third Geneva Convention. Retrieved May 10, 2006 from http://en.wikipedia.org/wiki/Third_Geneva_Convention
World Medical Association (2004) Ethical Principles for Medical Research Involving Human Subjects. World Medical Association Declaration Of Helsinki. Retrieved May 8, 2006 from http://www.wma.net/e/policy/b3.htm
No comments:
Post a Comment