BIOETHICS
LECTURE 6
1) Ethics Committee
2) Ethics Commission
3) Ethics Commissions in Egypt
4) Examples of Applied Bioethical Principles
in Medical Practice and Healthcare System
1) ETHIC S COMMITTEE
An Ethics Committee, sometimes called an Institutional Review Board (IRB) or Institutional Ethics Committee
(IEC), helps make sure individuals involved in research projects receive appropriate protections while
contributing valuable knowledge.
Definition
A group formed to discuss matters involving morality and rights – especially around topics connected to
science, medicine, and society.
They evaluate proposals (research protocol) dealing with humans or sensitive situations.
Historical Context
After unjust actions in Nazi Germany and America's Tuskegee syphilis experiment, countries started
forming groups dedicated to safeguarding vulnerable populations engaged in research activities. These
bodies follow internationally recognized documents like the Nuremberg Code and the Declaration of
Helsinki.
1) ETHIC S COMMITTEE
Key Principles
Ethics Committees usually base their evaluations on fundamental principles found throughout various fields
of bioethics:
1. Respect for Autonomy: Individuals get to choose based on personal beliefs and preferences
2. Beneficence: Act positively toward someone else
3. Nonmaleficence: Avoid causing intentional injury
4. Justice: Fairness in sharing burdens and rewards
5. Privacy Protection: Safeguard private info shared confidentially
6. Truthfulness: Speak accurately about plans and outcomes
1) ETHIC S COMMITTEE
Real-World Example
Imagine scientists want to test a potential COVID vaccine worldwide. Before starting,
they submit detailed project descriptions to local Ethics Committees who scrutinize
every aspect according to applicable laws and codes. If approved, monitoring continues
after launch to prevent misconduct.
2) ETHIC S COMMISS ION
Definition
An Ethics Commission, similar to an Ethics Committee, reviews moral challenges faced by institutions,
professionals, or researchers. Their goal is to protect people affected by complex choices and promote
high ethical standards.
Historical Context
In the USA, modern Ethics Commissions began emerging due to significant societal shifts and controversial
incidents:
• Landmarks included the 'God Committee’, deciding life & death in kidney transplants, and court rulings
surrounding terminally ill patients' treatment
• Events highlighted tensions between advancing technologies, diverse cultural views, and urgent decision-
making pressures
• Growth accelerated in the 1980s and reached almost all major US hospitals by the mid-1990s
2) ETHIC S COMMISS ION
In 1962, Seattle’s Swedish Hospital established what later came to be called
the «God Committee»
Formally known as the Admissions and Policy Committee of the Seattle Artificial Kidney
Center at Swedish Hospital, its task was to decide which terminal patient would get
access to scarce dialysis machines, or artificial kidneys, as they were called then
3) ETHIC S COMMIS SION_ EG YPT
Definition: An entity tasked with ensuring proper evaluation and supervision of
research protocols, primarily focused on maintaining ethical practices and respecting
individual rights
Key Principles: Adherence to core values such as autonomy, justice, beneficence,
nonmaleficence, confidentiality, honesty, and fair subject selection
Real-World Examples: Consider a hypothetical scenario where pharmaceutical
companies seek permission to run drug efficacy tests in rural communities near Luxor.
Local RECs examine each step carefully before granting approvals
Historical Context: Establishments of RECs gained momentum in response to
increased global attention towards research ethics, notably influenced by events leading
up to the creation of networks like the Egyptian Network of Research Ethics
Committees (ENREC) in 2008
3) ETHIC S COMMIS SION_ EG YPT
• In June 2010, Presidential Decree no. 277 was issued concerning ‘Regulations Governing Clinical Trials’,
which addressed several important areas aligned with accepted bioethical norms
• More recently, Ministerial Order MHESRTMN/1/2020 established regulations that govern human
genetic data processing activities under the Ministry of Health and Population
• Acknowledging the need for improved oversight over scientific studies conducted nationwide, the
Supreme Council of Universities formed the Central Administration for Scientific Research Affairs at
universities across Egypt during October–December 2017. This move aimed to enhance coordination
among various university departments conducting research projects
• To address growing needs in genomic medicine applications, Cairo University launched their Center
for Genomics Medicine in April 2018; it has been instrumental in promoting awareness and education
efforts revolving around genomics technology utilization
4) EX AM PLE S OF AP PLIE D BIO ET HIC AL P RINC IP LES
IN M ED IC AL P RAC TICE AND HEALT HC ARE SYSTEM
Example 1: Conflict Between Beneficence and Autonomy
Scenario: Imagine a situation where a person, who has been diagnosed with advanced lung cancer,
decides not to undergo surgery that could potentially extend their life. The doctors have
recommended the surgery, but the patient believes that the negative effects of the surgery are
not worth the possibility of living longer. Instead, they choose to receive palliative care, which
focuses on relieving symptoms and improving quality of life rather than curing the illness.
Guiding Principles: In this scenario, we encounter a conflict between two important ethical
principles in healthcare. The first principle is beneficence, which encourages healthcare providers
to take actions that promote the well-being of their patients. The second principle is autonomy,
which respects the rights of individuals to make their own decisions about their medical
treatment and personal matters.
Reference: National Institute of Health
4) EX AM PLE S OF AP PLIE D BIO ET HIC AL P RINC IP LES
IN M ED IC AL P RAC TICE AND HEALT HC ARE SYSTEM
Example 1: Conflict Between Beneficence and Autonomy
In this scenario, although the surgeon is tasked with carefully considering both sides of
the dilemma, recognizing the significance of respecting patients' dignity and autonomy is
important.
Even if it may appear counterintuitive to prioritize patients' choices over treatments that
could potentially improve their health, it is essential to acknowledge and honor the
diverse values and perspectives of all involved parties.
Therefore, fostering open communication and dialogue is crucial in reaching decisions
that are ethically correct and mutually agreeable.
4) EX AM PLE S OF AP PLIE D BIO ET HIC AL P RINC IP LES
IN M ED IC AL P RAC TICE AND HEALT HC ARE SYSTEM
Example 2: Allocation of Scarce Resources Based on Justice
Scenario: In the midst of the global COVID-19 pandemic, governments around the world
are grappling with the challenge of distributing a limited supply of vaccines to their
populations. With a high demand for vaccines but limited availability, authorities face
tough decisions about how to prioritize access to vaccination.
Guiding Principle: The principle guiding these decisions is the concept of justice,
particularly social justice, which emphasizes fairness and equity in resource allocation.
Governments and health organizations strive to distribute vaccines in a way that is fair
and equitable, taking into account various factors and criteria.
Reference: National Institute of Health
4) EX AM PLE S OF AP PLIE D BIO ET HIC AL P RINC IP LES
IN M ED IC AL P RAC TICE AND HEALT HC ARE SYSTEM
Example 2: Allocation of Scarce Resources Based on Justice
As we have seen, many organizations have contributed their expertise to develop
guidelines and policies aimed at ensuring the efficient and fair distribution of vaccines.
These efforts prioritize the protection of high-risk communities and aim to maintain
public trust and confidence in vaccination efforts, which are crucial for effectively
combating infectious diseases like COVID-19.
By adhering to principles of justice and considering the needs of different populations,
authorities seek to navigate the complexities of vaccine distribution and ensure that
scarce resources are allocated in a manner that maximizes public health outcomes while
upholding ethical values.
4) EX AM PLE S OF AP PLIE D BIO ET HIC AL P RINC IP LES
IN M ED IC AL P RAC TICE AND HEALT HC ARE SYSTEM
Example 3: Truthful Communication Maintaining Veracity and Autonomy
Scenario: Imagine a scenario where a doctor, having confirmed a terminal illness through
diagnostic tests, decides to open this information, along with prognostic expectations, to
a cancer patient who is cognitively healthy.
Guiding Principles: This interaction is guided by two fundamental moral principles:
veracity, which refers to honesty, and respect for individual autonomy. By being truthful
about the diagnosis and prognosis, the doctor upholds integrity standards that are
essential for building trust in therapeutic relationships. Additionally, honest
communication enables the patient to make informed decisions about their care, aligning
with the principle of autonomy, which emphasizes individuals' right to make decisions
about matters that directly affect them.
Reference: ATRN CEU Course Content
4) EX AM PLE S OF AP PLIE D BIO ET HIC AL P RINC IP LES
IN M ED IC AL P RAC TICE AND HEALT HC ARE SYSTEM
Example 3: Truthful Communication Maintaining Veracity and Autonomy
In summary, this example underscores the importance of open and accurate
communication between doctors and patients, even when the information conveyed may
be distressing. It illustrates the interconnectedness of guiding principles such as honesty
and respect for autonomy, which together support mutual understanding and facilitate
shared decision-making. Each patient encounter presents unique circumstances that
require thoughtful consideration and tailored communication strategies to ensure that
the patient's values and preferences are respected.
4) EX AM PLE S OF AP PLIE D BIO ET HIC AL P RINC IP LES
IN M ED IC AL P RAC TICE AND HEALT HC ARE SYSTEM
Example 4: Avoid Harm Through Nonmaleficence During Urgent Procedure
Scenario: Consider a scenario where medical professionals insert intravenous (IV) lines
into a severely wounded individual who has sustained critical injuries from traumatic
events. These IV lines are essential for maintaining vital signs and providing fluids until
further treatment options become available.
Guiding Principle: In this situation, the guiding principle is nonmaleficence, which
emphasizes the duty to minimize harm. Despite the temporary pain or discomfort that
may result from procedures such as inserting IV lines, medical professionals prioritize the
immediate need to stabilize the patient's condition and prevent further harm. While
invasive techniques may cause short-term inconvenience, they are essential for achieving
larger goals of preserving life and facilitating the patient's recovery.
Reference: National Institute of Health
4) EX AM PLE S OF AP PLIE D BIO ET HIC AL P RINC IP LES
IN M ED IC AL P RAC TICE AND HEALT HC ARE SYSTEM
Example 4: Avoid Harm Through Nonmaleficence During Urgent Procedure
In summary, this example illustrates the delicate balance healthcare providers must
navigate between causing minimal, inevitable momentary hardships and achieving optimal
outcomes in terms of life preservation and recovery. It underscores the practical
application of foundational biomedical ethics frameworks, such as nonmaleficence, which
are central to decision-making in various healthcare settings, including medicine, nursing,
and allied health professions.