Is it morally Ethical to tell others what is morally correct?

joepistole · Feb 5, 2008

I have always been amazed that some folk think they are the ultimate arbiters of what is and is not ethical. So what does one need to be become a ethicist and is it ethical to do so?

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sowhatifit'sdark · Feb 5, 2008

joepistole said: ↑

I have always been amazed that some folk think they are the ultimate arbiters of what is and is not ethical. So what does one need to be become a ethicist and is it ethical to do so?
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You are perhaps aware that you are doing the same thing here.

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gurglingmonkey · Feb 5, 2008

oooh, self-referential pwnage.

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Fraggle Rocker · Feb 5, 2008

Parents are ethicists. It is their job to explain to their children what is right and wrong.

As for adults, it doesn't take much more than a computer and an internet connection to start telling people what is right and wrong. But people don't have to take your advice. Advice columnists, psychotherapists, and other counselors attain authority because their ideas of right and wrong withstand the test of time.

In the case of a psychotherapist there's a considerable body of formal study involved, but ultimately one's counsel must still be tested by those one counsels. In the case of an advice columnist you have to provide a sample that satisfies the sensibilities of the editor of a small newspaper. If he hires you he reads the letters that people write back about the validity of your advice. Eventually the editor of a larger paper will notice you and if you're really good some day you get to be Miss Manners or Ann Landers.

If you're just one old guy like me, giving advice to the younger generation on a website, the same thing is still happening. I don't get a lot of feedback but no one has written back to tell me my advice sucked and at least a handful of people have said it worked. It helps a lot to stick to subjects that you have some experience with. Duh.

This is the scientific method at work. You develop theories and people test them for you.
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Asguard · Feb 5, 2008

That depends on what context you are using. If your a medical scientist then an ethics comittie will tell you what is ethical for your entire life. This is because one person cant be trusted to act in an ethical fasion all the time when there job is on the line. They also cant be trusted to KNOW what is ethical all the time

sowhatifit'sdark · Feb 5, 2008

I've noticed that you can't trust groups to act ethically or know what is ethical either. In fact many of the worst acts in history.....

Asguard · Feb 5, 2008

true but an open ethics commity is more likly to act ethically than one lone doctor with a theory he wants to prove.

One specific example is what happened in the NZ hospital. A doctor was convinced that abnormal papsmears WONT become cirvical cancer. He did resurch to prove this WITHOUT telling the women what was happerning and ignoring the results that told him he was wrong. He killed god knows how many women by his "resurch". I wish i could give you a link to the story but i cant even rember if it was the 7:30 report or 4 corners. I will try to find a transcript of it if i can

Challenger78 · Feb 5, 2008

Fraggle Rocker said: ↑

Parents are ethicists. It is their job to explain to their children what is right and wrong.

As for adults, it doesn't take much more than a computer and an internet connection to start telling people what is right and wrong. But people don't have to take your advice. Advice columnists, psychotherapists, and other counselors attain authority because their ideas of right and wrong withstand the test of time.

In the case of a psychotherapist there's a considerable body of formal study involved, but ultimately one's counsel must still be tested by those one counsels. In the case of an advice columnist you have to provide a sample that satisfies the sensibilities of the editor of a small newspaper. If he hires you he reads the letters that people write back about the validity of your advice. Eventually the editor of a larger paper will notice you and if you're really good some day you get to be Miss Manners or Ann Landers.

If you're just one old guy like me, giving advice to the younger generation on a website, the same thing is still happening. I don't get a lot of feedback but no one has written back to tell me my advice sucked and at least a handful of people have said it worked. It helps a lot to stick to subjects that you have some experience with. Duh.

This is the scientific method at work. You develop theories and people test them for you.
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DUDE. Your advice never sucked. even if i don't use it. ...

Everyone develops their own morals. Parents are guides, but eventually, what parents leave out society finishes..One way or the other. Is it ethical ? Yes, If you know enough about the subject matter and aren't a hypocrite. For example, Bill O reilly has no right to tell me who I may or may not screw, because he isn't me. Some things are best left to yourself and no one else. A non doctor has no right to tell a doctor what is morally correct in his/her line of work, because the non doctor hasn't been there. Again, no one person is the arbiter, rather its a society. Often, we don't have the credentials to tell people what to do , but we do it anyway. (why? I don't know).

Asguard:Yes, context. One who deals with life and death on a daily basis is more qualified to tell what is morally correct than a random protester etc.

On another note : Is it right for One civilization to tell others what is or is not morally correct, even though they may view the world differently.

Asguard · Feb 5, 2008

Im sorry this is all i could find on it so far, if anyone knows any more i would welcome them posting it

video list said:

V44 Unethical practices of doctors in NZ - women guinea pigs in cervical cancer research - comparison to Chelmsford. Four Corners programme 42 mins Comment; quite unbelievable and frightening.

Viewed 05/02/08 at 22:48
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Asguard · Feb 5, 2008

Actually your wrong about that. Non medical personal especially ethists are an essential part of ethics commities. I would LOVE to find more info on that case because it shows exactly WHY non medical personal are used as a PART of an ethical commitie

Challenger78 · Feb 5, 2008

Asguard said: ↑

Actually your wrong about that. Non medical personal especially ethists are an essential part of ethics commities. I would LOVE to find more info on that case because it shows exactly WHY non medical personal are used as a PART of an ethical commitie
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What, so the entire medical community is so fixated on finding a cure that it uses unethical means ?

sowhatifit'sdark · Feb 5, 2008

Asguard said: ↑

true but an open ethics commity is more likly to act ethically than one lone doctor with a theory he wants to prove.

One specific example is what happened in the NZ hospital. A doctor was convinced that abnormal papsmears WONT become cirvical cancer. He did resurch to prove this WITHOUT telling the women what was happerning and ignoring the results that told him he was wrong. He killed god knows how many women by his "resurch". I wish i could give you a link to the story but i cant even rember if it was the 7:30 report or 4 corners. I will try to find a transcript of it if i can
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I get the gist of the story and I don't doubt in the least that such things happen. Probably people who end up wanting to be on ethics committees are less likely to, as a group, do henious things if they are chosen from a diverse set of backgrounds. This should create a kind of muddling middle way that will not satisfy or outrage the population as a whole now, though later in history they may seem to have done horrible things.

But this part of your post is on the rigged side:

true but an open ethics commity is more likly to act ethically than one lone doctor with a theory he wants to prove.
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Sure they would tend to act more ethically that unethical people.

joepistole · Feb 5, 2008

I guess my issue with ethics professionals is when they try to start limiting technology. For example, if I wanted to clone myself, I would not want an ethicist telling me I could not do so...not that I would want to. I think medical ethicists are largely a waste!
In this case, the ethicist is preventing me from accessing technology. Why gives him/her the right to prevent me from exercising my life the way I choose to? I am not hurting them.

Syzygys · Feb 5, 2008

I don't know if it is morally ethical, but it is definitely ethically moral....

sowhatifit'sdark · Feb 5, 2008

joepistole said: ↑

I guess my issue with ethics professionals is when they try to start limiting technology. For example, if I wanted to clone myself, I would not want an ethicist telling me I could not do so...not that I would want to. I think medical ethicists are largely a waste!
In this case, the ethicist is preventing me from accessing technology. Why gives him/her the right to prevent me from exercising my life the way I choose to? I am not hurting them.
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there are thousands of laws that restrict access to and use of technology.

joepistole · Feb 5, 2008

sowhatifit'sdark said: ↑

there are thousands of laws that restrict access to and use of technology.
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not all laws are ethical

Fraggle Rocker · Feb 5, 2008

Challenger78 said: ↑

On another note : Is it right for One civilization to tell others what is or is not morally correct, even though they may view the world differently.
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That's a tough call that probably has to be made on a case-by-case basis. We libertarians are convinced that no human being ever has the right to kill another, except in self-defense against an immediate threat. This means that we can't support societies that believe in honor killings. We will all try to convince them to stop.

Asguard · Feb 6, 2008

Challenger we study ethics as part of our degree. That is where i came across this case in class.

To start that class we were given a senario on abnormal papsmear resurch and we had to decide if as an ethics commity we would alow it and if we did what strictures we would put in place. I would like to say that every group voted to alow the resurch BUT we would have had uninvoled gynocologists checking the results with a view to the womens health rather than the resurch and we would have had pycologists checking that the women understood what they were getting into. After all medical resurch RARLY benifits those its tested on.

After we had made our desion we were told that it wasnt a hypothetical it was based on a real case and we watched that video. It made me sick to see not only the abuse by the resurcher but also the medical proffessionals who looked the other way. Including a pathologist (i think) from a hospital in England (again im not sure but i know he was an international doctor not atached to the hospital involved) who said that this theroy had been disproved already AND that he was harming his patient but STILL never went to the health department, the media OR the courts to STOP the unethical resurch

I have found what i THINK is the inquiry on this so it will hopefully be my next post (i just want to read through it first before posting it)

Asguard · Feb 6, 2008

This is from a book on the cartwright inquiry and doctor Green

Sandra Coney said:

Discussion of the ethics of the study never appeared in his papers. It never seems to have occurred to Green to worry about medical ethics because he believed so absolutely that women with CIS would not develop invasive cancer. Green wrote: 'If the physician does not worry too much about the disease, then neither will the patient.' A letter written by Green to a GP in 1965 gives an idea of the sort of message Green was conveying to his patients. The patient had only had a punch biopsy. 'Mrs G,' wrote Green, 'seemed prepared to accept my reassurance on the subject that she is in no danger of developing true cancer . . .'

In answer to a question from us about whether women were told there were differences of opinion about the methods of treatment, Green replied: 'I suppose not.' In answer to the same question, Professor Bonham said: 'I wouldn't know, you would have to ask each individual doctor who treated patients.'

Although the HMC, which passed the study, acted as an ethical committee, there was no hospital plan to seek the agreement of the women to their unorthodox management. Consequently, patients like Clare Matheson did not know they were being studied, nor that they were being treated in an unorthodox way.

Viewed 06/02/08 at 10:46
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This is from the summery of the incidence

The Report of the Cervical Cancer Inquiry 1988 Judge Silvia Cartwright said:

Medical Ethics

1) Clinical freedom: "Now the patient must be involved in decisions concerning her management and medical colleagues must intervene if there is a risk to the patient for any reason. The doctor is no longer wholly autonomous. Clinical freedom has been proved worthless at NWH when patients' safety or the rigorous testing of a new treatment protocol were at stake." (pl29)

2) Peer Review: "When it came to evaluating or reviewing the 1966 trial, Dr Green's peers failed him. Twenty-one years after the first oral and written challenge to the proposal, an article in a non-medical magazine achieved in a few days what his colleagues could not." The concerns raised by McIndoe, McLean, Warren and Jones through the superintendent-in-chief, a world authority and the HMC - "all this counted for nothing." The publication of the 1984 and 1986 papers "hardly seemed to cause a ripple among the staff at NWH," the women were not recalled and reviewed. "Of even graver concern is the fact that the AHB took no steps to ensure that patients' welfare was not at risk even though it had known of the risks, through its medical superintendent, since 1975....I believe that unless the profession can establish adequate peer review and adequate systems to cope with the inevitable mistakes or problems caused by incompetence, then there will a continuing succession of inquiries of this nature." (pl31-137) At NWH, peerreview "is almost non-existent except at an informal level." (p212)

3) Informed Consent: As a consequence of the Accident Compensation Act 1972, "the law in New Zealand relating to informed consent may need to be spelled out specifically." The patient has the right to "all relevant information... The focus should be centred on the patient, and not on the doctor." If the women in the 1966 study had been informed "then it is my firm view that fewer patients' carcinoma in situ would have progressed to invasion. The investigator should have sought the patients' consent... These are principles which have been clearly enunciated throughout the period that the 1966 trial has been in operation, but which were breached from the outset." (pl36-137) Consent, however, would not have freed the investigator from responsibility because the study was "flawed in design." The patient must freely give consent to all treatment and research. There must be full disclosure. The doctor has an obligation to understand cultural perspectives and where "yes" might be just a desire to please. There should be more written information for patients. (pl37)

4)Research: The NWH Ethical Committee had no established procedures for evaluating research, for independent assessment, referees, or reviewing the science. It has no formal guidelines and no written principles or special application forms to guide researchers such as those used by the Auckland Hospital Ethical Committee. (pl 39-144) Most projects "appear not to have received adequate scientific assessment in all cases..." (p212)
The judge reviewed ten years working of the committee, leaving her with "serious reservations." Consent forms were rarely included in proposals. Prof Bonham as head of department and post-grad school, chaired ali meetings and never stepped down. Most of the proposals came from his department, even from himself. Thus the committee lacked independence. (pl45) No existing research projects were reviewed, the publication of results is "not encouraged or enforced" (p212), the sole lay member was male, a retired pharmacist and deputy coroner.
The NWH Ethical Committee had not always achieved the objective of ensuring that unethical practices do not occur. These inadequacies "pose a serious risk to patients' rights." (p212)
The judge specifically criticised the reply of Prof Bonham to a letter to the Ethical Committee about the 1966 study written by Phillida Bunkle. (pl49-151)
The judge decided the ethical committee "has demonstrated no sense of responsibility to the public in providing accurate information when it is sought and on at least one occasion suppressed information in case of public reaction. It lacked independence and impartiality during the period covered by the minutes I have seen. Lay representation has been inadequate." The AHB has shown little interest in it. "I have come to the conclusion that NWH is too small an institution and too closely associated with the Postgraduate School to be entrusted with the critical task of evaluating scientific and ethical content of in-house research proposals." (p151) She recommends it be disbanded and a more "detached" ethical committee should be established.
The AHB under the supervision of the Director-General of Health should develop "one or more ethical committees for assessment of all projects in its institutions." (p212)

What the Women Knew

Of the women the judge interviewed, only one knew she was being studied. "I disagree with the suggestion of one witness that many patients lack the intelligence to grasp essential information. In general, the level of information received by the patients I met was poor. It is disturbing that on occasions patients felt confident they had had full and accurate information when in fact that had not been the case." (plS6) "Only a minority of women or relations of patients who spoke to me had grievances about their treatment, about NWH or about any member of the medical staff. After reading their files and listening to their experiences I could only conclude that the vast majority of the people I talked to had so little knowledge of the nature of the condition for which they or their relatives were being monitored, that they had no basis from which to formulate a complaint." (plS7)

Patients' Rights

1) Consent: All treatments under anaesthetic must have written consent. The consent form must specify what the patient has been told and to what she has consented. "In the light of the evidence I have heard, the Hospital should consider providing the patient with a written summary of possible risks. I consider it is insufficient... "to make a general statement that the nature, effects and risks of a treatment have been explained. The consent form should name the doctor. (plS8)

2) Translators: "It is inappropriate for relatives or members of the hospital staff who are not in a confidential relationship with the patient to undertake this task." (plS8) "The AHB should urgently consider employing and training interpreters who would be bound by the rules of patient confidentiality. They would be available to help explain treatment or procedures and ensure that the woman's consent is freely given... These services should be publicised throughout the hospital and a woman should have easy access to an interpreter's help. Health professionals proficient in the patient's language may often be the most appropriate to manage that case. Other hospital workers, relatives, and friends should not be relied on as interpreters." (pl59)

3)Patients' Rights Code: The judge was concerned about the manner of its distribution, that it was kept in wardrobes. She said this was "inadequate." "It may be that the staff place little emphasis or importance on the provision of the document. I was informed by Dr Collison that this Code of Rights could be handed to each patient as she was admitted to hospital. I believe it ought to be freely available to out-patients as well." (pl59)

4)Women are entitled to privacy and modesty. She should be able to meet her consultant fully dressed and change for examination. Gowns must be available in all sizes. Patients should not be able to be overheard. (plS9)

5)Consent to teaching: Permission should always be sought for students to be present "before they enter her cubic or room." (plS9-160)

6)Colposcopy should be private, a female staff member should be present or available, she should be able to have a relative or friend with her, she should be able to see what the colposcopist is doing. (pl60)

7)Out-patients: Waiting periods must be reduced: "The principle should be that hospital care is for the patient, and not for the convenience of the doctors and other staff. (pl60) Consideration should be given to decentralising out-patient clinics.

8)Attitudes: The judge relayed a recent experience of a patient at an out-patient clinic. The woman was kept waiting hours, had a rough and painful examination, and was told it was all in her mind: "The type of experience has been described on several occasions during patient interviews. I was concerned, however, that even while the Inquiry was still sitting, patients were being treated in this manner." (pl61)
The judge also detailed the experience of a woman being treated for invasive cancer between 1984 and 1987 and concluded: "To be made to feel a nagger, a nuisance and a person with a poor attitude is extraordinarily insensitive. If the staff at NWH cannot cope with women who are seriously ill, the' other health professionals such as social workers must be introduced to the system urgently, to assist with communication, reassurance and support, both for the patient and he family." (pl62-167)

9)Consent to Research: There must be full information and consent given freely. She must not be in a dependent relationship to the researcher, must not feel under any obligation, must have a good grasp of English and have time to decide and consult family and friends: "These rules have seldom been observed in clinical trials at NWH.' (pl67)
The judge discovered that some women had been included in several trials without their consent

viewed 06/02/08 at 10:57
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Now if you have made it this low down my post congratulations
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Seriously though this incident made me sick not because people died, people DO die in medical resurch but because there was no informed concent to the resurch. The women didnt even KNOW they weren't being given the standed treatment. Whats worse NO ONE spoke out about it and DELT with the situation. Not the other senior doctors who felt it wasnt there place to invove themselves in another doctors work. Not the journor doctors or nurses who Dr Green intimdated and NOT the hospital administration when it was reported to them

joepistole · Feb 6, 2008

Much of ethics seems to me to be just good old common sense. Am I missing something?

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