Page 116 - ACCCN's Critical Care Nursing

Ethical Issues in Critical Care 93

Challenging Ethical Issues in Contemporary Research on Some hospitals have established multidisciplinary ethics
Human Beings 2006. 86 committees to provide a closed forum for clinicians to
raise ethical and legal concerns associated with particular
Research proposals involving human participants must
be reviewed and approved by a formally constituted EC treatments or decisions. These are distinct from the
that is established by, and advises, an institution or research ethics committees that examine the ethical
organisation regarding ethical approval for research pro- implications and recommend safeguards for research
jects. An EC must ensure that it is sufficiently informed projects. They are advisory and do not tell the clinicians
on all aspects of submitted research proposals, and is what to do, but do make recommendations. These con-
charged with the responsibility to ensure that investiga- sultations or meetings have yet to routinely include
tors undertaking human research are adequately knowl- patients in the discussions, but must take into account
edgeable and skilled in the research question and patients’ wishes. In addition to providing clinicians with
associated methodology. Additional expertise may be advice on particular cases these committees may also
sought either from individuals or from specific dedicated assist with the development of organisational policies on
‘shared assessment scheme’ groups as considered patient care and facilitate staff and patient education
necessary. 19 about ethical issues.
Presentation in person to HRECs in Australia is not
18
common but may be requested for complex protocols. PRIVACY AND CONFIDENTIALITY
In New Zealand, presentation in person to the IEC, while Privacy is a fundamental human right recognised in all
not compulsory, is common practice and highly recom- major international treaties and agreements on human
mended, as it often provides additional clarification. rights. Nearly every country in the world recognises
privacy as a fundamental human right in their constitu-
EC members have legal responsibilities in the following tion, either explicitly or implicitly. Most recently drafted
broad areas in relation to research subjects, researchers constitutions include specific rights to access and control
and their institutions: one’s personal information. New technologies are increas-
● negligence ingly eroding privacy rights. These include video surveil-
● breach of natural justice lance cameras, identity cards and genetic databases. There
● privacy is a growing trend towards the enactment of comprehen-
● breach of commercial confidentiality sive privacy and data protection acts around the world.
● defamation. Currently over 40 countries and jurisdictions have or are
87
in the process of enacting such laws. Countries are
CLINICAL ETHICS adopting these laws in many cases to address past
governmental abuses (such as in former Eastern Bloc
Clinical ethics relate to the moral and ethical issues and/
or conflicts that arise in everyday clinical practice. Ethical countries), to promote electronic commerce, or to ensure
dilemmas are hence a fact of life for healthcare clinicians compatibility with international standards developed by
and may involve any combination of patients, carers, the the European Union, the Council of Europe, and the
treating team, and family members. Healthcare services Organization for Economic Cooperation and Develop-
are delivered by individuals who hold a wide variety of ment. Surveillance authority is regularly abused, even in
beliefs and values with patients treated from a wide many of the most democratic countries. The main targets
variety of social, economic and cultural backgrounds and are political opposition, journalists and human rights
of different ages and capacity. activists. The US government is leading efforts to further
relax legal and technical barriers to electronic surveil-
Patients and healthcare workers bring their own life lance. The Internet is coming under increased
experiences as well as their own cultural, religious and surveillance. 88
linguistic backgrounds to their healthcare bedside set-
tings. Clinicians should provide care to all who need it Privacy legislation is described in the Privacy Act 1993
that respects, honours and supports cultural diversity. (with subsequent amendments in 1997, 1998, 2000,
Cultural competence describes the knowledge, skills and 2002, 2003 and 2005) in New Zealand and the Common-
attitudes that a healthcare worker needs to provide ade- wealth Privacy Act 1988 in Australia. While these two
quate and appropriate healthcare services to all people in pieces of legislation have many common features, they
this way. also have a number of differences, and their principles
are described below.
Within the clinical ethics remit, it is important to:
The Privacy Act 1993 is based on a series of 12 informa-
1. Organise and use interpreters appropriately. tion privacy principles (IPPs) (in Section 6) that outline
2. Create care environments that facilitate optimal the purpose, source, collection, access, storage, disclosure
patient and family control of decisions. and use of information throughout New Zealand. In
3. Work collaboratively with other healthcare workers addition the Act contains various codes of practice that
in a culturally sensitive and competent manner. relate to the use of information, and provides detail
4. Identify and address bias, prejudice and discrimi- regarding exemptions from the IPPs. Of note, the Act also
nation in healthcare service delivery. details (in Sections 12 – 25) the establishment and opera-
5. Integrate measures of patient satisfaction into tion of a Privacy Commissioner (see Online resources for
improvement programs. website address). The purpose of the Commissioner is to