Research and complicity: the case of Julius Hallervorden

The charge of complicity has been raised in debates over the ethics of fetal tissue transplantation and embryonic stem cell research. However, the applicability of the concept of complicity to these types of research is neither clear nor uncontroversial. This article discusses the historical case of Julius Hallervorden, a distinguished German neuropathologist who conducted research on brains of mentally handicapped patients killed in the context of the Nazi 'euthanasia' programme. It is argued that this case constitutes a paradigm of complicity in research that is useful in assessing complicity in contemporary research ethics.

Damned if you do, damned if you don't? The Lundbeck case of pentobarbital, the guiding principles on business and human rights, and competing human rights responsibilities

In 2011 it emerged that to induce the death penalty, United States authorities had begun giving injections of pentobarbital, a substance provided by Danish pharmaceutical company Lundbeck. Lundbeck's product pentobarbital is licensed for treatment of refractory forms of epilepsy and for usage as an anaesthetic, thus for a very different purpose. The Lundbeck case offers a difficult, but also interesting Corporate Social Responsibility (CSR) dilemma between choices facing a pharmaceutical company to stop the distribution of a medical substance in order to avoid complicity in human rights violations, or to retain distribution of the substance in order not to impede access to the medicine for those patients who need it. The dilemma arose at a time when the United Nations (UN) Secretary General's Special Representative on Business and Human Rights, Professor John Ruggie, was finalizing a set of Guiding Principles to operationalize recommendations on business and human rights that he had presented to the UN Human Rights Council in 2008. The article discusses the dilemma in which Lundbeck was placed in from the perspective of the Guiding Principles on business and human rights and the 2008 Protect, Respect, Remedy UN Framework. The analysis seeks to assess what guidance may be gauged from the Guiding Principles in relation to the dilemma at hand and discusses the adequacy the Guiding Principles for dealing with acute human rights dilemmas of conflicting requirements in which a decision to avoid one type of violation risks causing violation of another human right. The article concludes by drawing up perspectives for further development of guidance on implementation of the UN Framework that could be considered by the newly established Working Group on Business and Human Rights and related UN bodies.

When negative rights become positive entitlements: complicity, conscience, and caregiving

Clinicians have an obligation to ensure that patients with adequate capacity can make autonomous decisions. Thus, patients who choose to forego treatment and leave hospitals "against medical advice" are typically allowed to do so. But what happens when they require clinicians' assistance to physically leave? Is it incumbent upon clinicians to not only respect and fulfill patients' requests with which they disagree, but to physically assist in their fulfillment? We attempt to develop an ethical framework wherein clinicians can honor patients' wishes without necessarily sacrificing their own moral position.

Neglect of medical evidence of torture in Guantánamo Bay: a case series

BACKGROUND

In the wake of the September 11, 2001 attacks on the US, the government authorized the use of "enhanced interrogation" techniques that were previously recognized as torture. While the complicity of US health professionals in the design and implementation of US torture practices has been documented, little is known about the role of health providers, assigned to the US Department of Defense (DoD) at the US Naval Station Guantánamo Bay, Cuba (GTMO), who should have been in a position to observe and document physical and psychological evidence of torture and ill treatment.

METHODS AND FINDINGS

We reviewed GTMO medical records and relevant case files (client affidavits, attorney-client notes and summaries, and legal affidavits of medical experts) of nine individuals for evidence of torture and ill treatment and documentation by medical personnel. In each of the nine cases, GTMO detainees alleged abusive interrogation methods that are consistent with torture as defined by the UN Convention Against Torture as well as the more restrictive US definition of torture that was operational at the time. The medical affidavits in each of the nine cases indicate that the specific allegations of torture and ill treatment are highly consistent with physical and psychological evidence documented in the medical records and evaluations by non-governmental medical experts. However, the medical personnel who treated the detainees at GTMO failed to inquire and/or document causes of the physical injuries and psychological symptoms they observed. Psychological symptoms were commonly attributed to "personality disorders" and "routine stressors of confinement." Temporary psychotic symptoms and hallucinations did not prompt consideration of abusive treatment. Psychological assessments conducted by non-governmental medical experts revealed diagnostic criteria for current major depression and/or PTSD in all nine cases.

CONCLUSION

The findings in these nine cases from GTMO indicate that medical doctors and mental health personnel assigned to the DoD neglected and/or concealed medical evidence of intentional harm.

Complicity in stem cell research: the case of induced pluripotent stem cells

Many who object to human embryonic stem cell (hESC) research because they believe it involves complicity in embryo destruction have welcomed induced pluripotent stem cell (iPSC) research as an ethical alternative. This opinion article aims to show that complicity arguments against hESC research are prima facie inconsistent with accepting iPSC research as it is currently done. Those who oppose hESC research on grounds of complicity should either (i) oppose iPSC research as well, (ii) advocate a radical change in the way iPSC research is done, (iii) demonstrate that complicity arguments against iPSC research are weaker than those against hESC research or (iv) reject complicity arguments against both hESC and iPSC research, either by adopting a more limited conception of complicity that allows acceptance of some hESC research, or by accepting that destroying embryos for important scientific research is not wrong.

Open doorway to truth: legacy of the Minnesota tobacco trial

More than a decade has passed since the conclusion of the Minnesota tobacco trial and the signing of the Master Settlement Agreement (MSA) by 46 US State Attorneys General and the US tobacco industry. The Minnesota settlement exposed the tobacco industry's long history of deceptive marketing, advertising, and research and ultimately forced the industry to change its business practices. The provisions for public document disclosure that were included in the Minnesota settlement and the MSA have resulted in the release of approximately 70 million pages of documents and nearly 20,000 other media materials. No comparable dynamic, voluminous, and contemporaneous document archive exists. Only a few single events in the history of public health have had as dramatic an effect on tobacco control as the public release of the tobacco industry's previously secret internal documents. This review highlights the genesis of the release of these documents, the history of the document depositories created by the Minnesota settlement, the scientific and policy output based on the documents, and the use of the documents in furthering global public health strategies.

Moral complicity in induced pluripotent stem cell research

Direct reprogramming of human skin cells makes available a source of pluripotent stem cells without the perceived evil of embryo destruction, but the advent of such a powerful biotechnology entangles stem cell research in other forms of moral complicity. Induced pluripotent stem cell (iPSC) research had its origins in human embryonic stem cell research and the projected biomedical applications of iPS cells almost certainly will require more embryonic stem cell research. Policies that inhibit iPSC research in order to avoid moral complicity are themselves complicit in preventable harms to patients. Moral complicity may be unavoidable, but a Blue Ribbon Panel charged with assessing the need for additional embryonic stem cell lines may ease a transition from embryonic stem cell research to clinical applications of iPS cells.

The prevalence of academic dishonesty in Texas dental hygiene programs

The media has given much attention to the academic cheating crisis in America. A majority of college students believe that, in today's global environment, it is necessary to cheat in order to get ahead and to compete with their peers. The prevalence and attitudes concerning academic dishonesty of health professions students, including those in medical, dental, and nursing schools, have been extensively researched. No such studies exist in the discipline of dental hygiene. The purpose of this study was to investigate the prevalence of cheating in Texas dental hygiene programs. Four hundred surveys were mailed to twenty Texas dental hygiene schools for graduating students to complete. A total of 289 usable surveys was returned for a response rate of 72.25 percent. Data were analyzed using SPSS with frequencies and chi-square tests. Findings from this study reveal that 86.5 percent of graduating Texas dental hygiene students have cheated a minimum of one time during matriculation. Students identified the demands of what they considered academic overload as the primary justification for cheating behavior.

The balancing act: psychiatrists' experience of moral distress

Experiences of moral distress encountered in psychiatric practice were explored in a hermeneutic phenomenological study. Moral distress is the state experienced when moral choices and actions are thwarted by constraints. Psychiatrists describe struggling 'to do the right thing' for individual patients within a societal system that places unrealistic demands on psychiatric expertise. Certainty on the part of the psychiatrist is an expectation when judgments of dangerousness and/or the need for coercive treatments are made. This assumption, however, ignores the uncertainty and complexity of reality. Society entrusts psychiatrists to care for and treat those among its most vulnerable members: persons deemed to have a severely diminished capacity for autonomy due to a mental disorder. Simultaneously, psychiatrists are held accountable by society for the protection of the public. Moral distress arose for psychiatrists in their efforts to fulfill both roles. They described an 'outsider/insider' status and the ways in which they attempted to cope with moral distress.

Implementing moral case deliberation in a psychiatric hospital: process and outcome

BACKGROUND

Clinical moral case deliberation consists of the systematic reflection on a concrete moral case by health care professionals. This paper presents the study of a 4-year moral deliberation project.

OBJECTIVES

The objectives of this paper are to: (a) describe the practice and the theoretical background of moral deliberation, (b) describe the moral deliberation project, (c) present the outcomes of the evaluation of the moral case deliberation sessions, and (d) present the implementation process.

METHODS

The implementation process is both monitored and supported by an interactive responsive evaluation design with: (a) in-depth interviews, (b) Maastricht evaluation questionnaires, (c) evaluation survey, and (d) ethnographic participant observation. In accordance with the theory of responsive evaluation, researchers acted both as evaluators and moderators (i.e. ethicists).

RESULTS

Both qualitative and quantitative results showed that the moral case deliberations, the role of the ethics facilitator, and the train-the-facilitator program were regarded as useful and were evaluated as (very) positive. Health care professionals reported that they improved their moral competencies (i.e. knowledge, attitude and skills). However, the new trained facilitators lacked a clear organisational structure and felt overburdened with the implementation process. The paper ends with both practical and research suggestions for future moral deliberation projects.

J. Robert Oppenheimer: a faith development portrait

J. Robert Oppenheimer was among the most important and enigmatic figures in 20th century science. He is best known for successfully directing the Manhattan Project that produced the first atomic bombs that were dropped on Japan at the end of World War II. Subsequently, he became a scientist and statesman who advised the United States government in the areas of atomic weapons development and public policy. He later became subject to an investigation in 1954 into his previous political affiliations and his personal behavior that ended in the revoking of his security clearance. This essay seeks to chronicle Oppenheimer's coming of age as a public intellectual with a view toward his own psychological history and most especially in relationship to the stages of faith development articulated by James Fowler and colleagues. Moreover, though not conventionally religious, Oppenheimer's life and thought were permeated with themes and ideas of a religious and ethical nature that shaped his adult character and informed his view of the world. This essay was originally presented at The Richardson History of Psychiatry Research Seminar at Weill Cornell Medical College.

Silent healers: on medical complicity in torture

OBJECTIVE

To shed light on a large but neglected human rights issue that can be termed passive participation in torture. This is a response to the rising number of statements from torture victims who claim that during their incarceration, medical personnel cooperated with the interrogators by sharing medical documents, giving false statements, and providing other indirect assistance to the interrogator.

METHOD

Cases studies are used to demonstrate the existence of passive participation, as well as situations where the passivity has been addressed and improved. Extracts of international instruments and actions undertaken by associations are used to help the reader address issues around the passive participation in torture.

RESULT

By reading this article medical professionals will be made aware that action can be undertaken with the help of existing international laws and policies.

CONCLUSION

In the conclusion of the article a range of bullet-points is made available for medical professionals who want to address the issue of passive participation.

Is military action ever justified? A physician defends the 'Responsibility to Protect'

This article initially examines the moral dilemmas of war from personal and family experience, from the perspective of a family doctor trained to preserve life and a member of the peace movement. It then explores Just War from religious viewpoints and the challenges to pacifism from those living in war zones, and from human rights and human security perspectives. It concludes that the Responsibility to Protect reflects sound medical principles balancing the need to make war an extreme last resort with the responsibility of the international community to assist those unable to defend themselves.

[When health makes the headlines. Press, elite complicities and health globalisation in Bamako, Mali]

To overcome the socio-medical failures observed in Africa's health services, researchers and practitioners of public health often mention the necessity to resort to counter-powers. But, what are precisely these counter-powers? To analyse the problem, we describe the treatment of health issues in the Bamako press during one year. The analysis of various processes (external references, lack of training, insufficient deontological standards, "elite" complicity among journalists and health directors) allows us to underline the complexity of the links between the press and health. The economic flows related to the economy of development "projects" in particular with AIDS, encourage the journalists to see themselves as "educationalists" of populations rather than spokesmen for their claims or difficulties. Two consequences follow. First of all the press counter-power has to be developed in the case one wishes to see it as the expression of "the voice of the voiceless" and a good help to make an "informal" evaluation of the quality of health cares by users. But, more generally within this context of globalisation of health, instead of encouraging the expression of a "popular" criticism, newspapers work out a system of mutual legitimacies and social connivances among local "elites". Far from contributing to the improvement of the health system by looking actively into the problem leading to a modernity under control, health journalism disconnects the discourse from its referent and contributes to discredit "political" language. This journalistic construction of the insignificance is one of the principal political effects of this medical journalism instrumentalized by institutions of development.

Medical ethics and the interrogation of Guantanamo 063

The controversy over abusive interrogations of prisoners during the war against terrorism spotlights the need for clear ethics norms requiring physicians and other clinicians to prevent the mistreatment of prisoners. Although policies and general descriptions pertaining to clinical oversight of interrogations in United States' war on terror prisons have come to light, there are few public records detailing the clinical oversight of an interrogation. A complaint by the Federal Bureau of Investigation (FBI) led to an Army investigation of an interrogation at the United States prison at Guantanamo Bay. The declassified Army investigation and the corresponding interrogation log show clinical supervision, monitoring and treatment during an interrogation that employed dogs, prolonged sleep deprivation, humiliation, restraint, hypothermia and compulsory intravenous infusions. The interrogation and the involvement of a psychologist, physician and medics violate international and medical norms for the treatment of prisoners.

Share, Steal, or Buy? A Social Cognitive Perspective of Music Downloading

The music downloading phenomenon presents a unique opportunity to examine normative influences on media consumption behavior. Downloaders face moral, legal, and ethical quandaries that can be conceptualized as normative influences within the self-regulatory mechanism of social cognitive theory. The music industry hopes to eliminate illegal file sharing and to divert illegal downloaders to pay services by asserting normative influence through selective prosecutions and public information campaigns. However the deficient self-regulation of downloaders counters these efforts maintaining file sharing as a persistent habit that defies attempts to establish normative control. The present research tests and extends the social cognitive theory of downloading on a sample of college students. The expected outcomes of downloading behavior and deficient self-regulation of that behavior were found to be important determinants of intentions to continue downloading. Consistent with social cognitive theory but in contrast to the theory of planned behavior, it was found that descriptive and prescriptive norms influenced deficient self-regulation but had no direct impact on behavioral intentions. Downloading intentions also had no direct relationship to either compact disc purchases or to subscription to online pay music services.

Benefiting from past wrongdoing, human embryonic stem cell lines, and the fragility of the German legal position

This paper examines the logic and morality of the German Stem Cell Act of 2002. After a brief description of the law's scope and intent, its ethical dimensions are analysed in terms of symbolic threats, indirect consequences, and the encouragement of immorality. The conclusions are twofold. For those who want to accept the law, the arguments for its rationality and morality can be sound. For others, the emphasis on the uniqueness of the German experience, the combination of absolute and qualified value judgments, and the lingering questions of indirect encouragement of immoral activities will probably be too much.

A brief history of human diploid cell strains

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Human technology manufacturing platforms

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The United States cover-up of Japanese wartime medical atrocities: complicity committed in the national interest and two proposals for contemporary action

To monopolize the scientific data gained by Japanese physicians and researchers from vivisections and other barbarous experiments performed on living humans in biological warfare programs such as Unit 731, immediately after the war the United States (US) government secretly granted those involved immunity from war crimes prosecution, withdrew vital information from the International Military Tribunal for the Far East, and publicly denounced otherwise irrefutable evidence from other sources such as the Russian Khabarovsk trial. Acting in "the national interest" and for the security of the US, authorities in the US tramped justice and morality, and engaged in what the English common law tradition clearly defines as "complicity after the fact." To repair this historical injustice, the US government should issue an official apology and offer appropriate compensation for having covered up Japanese medical war crimes for six decades. To help prevent similar acts of aiding principal offender(s) in the future, international declarations or codes of human rights and medical ethics should include a clause banning any kind of complicity in any unethical medicine-whether before or after the fact-by any state or group for whatever reasons.

Moral nature of the DSM-IV Cluster B personality disorders

Moral considerations do not appear to play a large role in discussions of the DSM-IV personality disorders and debates about their empirical validity. Yet philosophical analysis reveals that the Cluster B personality disorders, in particular, may in fact be moral rather than clinical conditions. This finding has serious consequences for how they should be treated and by whom.

On complicity theory

The received account of whistleblowing, developed over the last quarter century, is identified with the work of Norman Bowie and Richard DeGeorge. Michael Davis has detailed three anomalies for the received view: the paradoxes of burden, missing harm and failure. In addition, he has proposed an alternative account of whistleblowing, viz., the Complicity Theory. This paper examines the Complicity Theory. The supposed anomalies rest on misunderstandings of the received view or misreadings of model cases of whistleblowing, for example, the Challenger disaster and the Ford Pinto. Nevertheless, the Complicity Theory is important for as in science the contrast with alternative competing accounts often helps us better understand the received view. Several aspects of the received view are reviewed and strengthened through comparison with Complicity Theory, including why whistleblowing needs moral justification. Complicity Theory is also critiqued. The fundamental failure of Complicity Theory is its failure to explain why government and the public encourage and protect whistleblowers despite the possibility of considerable harm to the relevant company in reputation, lost jobs, and lost shareholder value.

An ethics of testimony: prisoner nurses at Auschwitz

This historical research report presents and analyzes 2 recently identified narratives of women who underwent sterilization experiments at the Auschwitz concentration camp during World War II. A description of the historical and contextual background is presented in which involvement of the prisoner nurse occurred in the sterilization experiments. Using a critical feminist perspective, the ethics of nursing involvement are discussed in these experiments, with an emphasis on the political dimension. Salient implications are explored for contemporary nursing.

Stem cell research in a Catholic institution: yes or no?

Catholic teaching has no moral difficulties with research on stem cells derived from adult stem cells or fetal cord blood. The ethical problem comes with embryonic stem cells since their genesis involves the destruction of a human embryo. However, there seems to be significant promise of health benefits from such research. Although Catholic teaching does not permit any destruction of human embryos, the question remains whether researchers in a Catholic institution, or any researchers opposed to destruction of human embryos, could participate in research on cultured embryonic stem cells, or whether a Catholic institution could use any therapy that ultimately results from such research. This position paper examines how such research could be conducted legitimately in a Catholic institution by using an ethical analysis involving a narrative context, the nature of the moral act, and the principle of material cooperation, along with references to significant ethical assessments. It also offers tentative guidelines that could be used by a Catholic institution in implementing such research.

The Ethics of HEK 293

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Complicity, Fetal Tissue, and Vaccines

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