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Ethics in Academic Surgery

  • Charles W. Kimbrough
  • Timothy M. PawlikEmail author
Chapter

Abstract

There is increasing awareness of the unique ethical issues inherent to clinical care and research, including the dual loyalties of the surgeon-scientist. Learning how to approach and manage ethical conflicts that may arise is critical for any academic surgeon. An understanding of the underlying ethical principles, past precedents, and the relevant regulations or guidelines can help guide moral reasoning and ethical decision-making. Voluntary informed consent, scientific value, and favorable risk-benefit ratios must be taken into consideration with all human subjects research. To preserve research integrity, good research practices must be observed, along with the avoidance of research misconduct including falsification, fabrication, and plagiarism. Conflicts of interest must be appropriately disclosed and managed. Moving beyond ethical principles as a guide for behavior, character needs to serve as a foundation for ethical decision-making.

Keywords

Ethics Human subjects research Research misconduct Informed consent Conflict of interest 

References

  1. 1.
    Resnik DB, Elliott KC. The ethical challenges of socially responsible science. Account Res. 2016;23(1):31–46.CrossRefGoogle Scholar
  2. 2.
    American College of Physicians Ethics Manual. Part I: history of medical ethics, the physician and the patient, the physician’s relationship to other physicians, the physician and society. Ad Hoc Committee on Medical Ethics, American College of Physicians. Ann Intern Med. 1984;101(1):129–37.CrossRefGoogle Scholar
  3. 3.
    Beauchamp TL, Childress JF. Principles of biomedical ethics. Oxford: Oxford University Press; 2012.Google Scholar
  4. 4.
    Pawlik TM, Schwarze ML. Ethics in surgical research. Success in Academic Surgery, Vol. 1. Springer lLink; 2017. p. 43–57.Google Scholar
  5. 5.
    Pawlik TM, Platteborze N, Souba WW. Ethics and surgical research: what should guide our behavior? J Surg Res. 1999;87(2):263–9.CrossRefGoogle Scholar
  6. 6.
    Beaumont W. Experiments and observations of the gastric juice and the physiology of digestion. Plattsburgh: FP Allen; 1833.Google Scholar
  7. 7.
    Moreno JD, Schmidt U, Joffe S. The Nuremberg code 70 years later. JAMA. 2017;318(9):795–6.CrossRefGoogle Scholar
  8. 8.
    The nuremberg code. JAMA. 2017;276(20):1691–1.Google Scholar
  9. 9.
    World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. JAMA. 2017;310(20):2191–4.Google Scholar
  10. 10.
    Beecher HK. Ethics and clinical research. N Engl J Med. 1966;274(24):1354–60.CrossRefGoogle Scholar
  11. 11.
    National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont report : ethical principles and guidelines for the protection of human subjects of research. Washington, D.C.: US Government Printing Office; 1979.Google Scholar
  12. 12.
    Friesen P, Kearns L, Redman B, et al. Rethinking the Belmont report? Am J Bioeth. 2017;17(7):15–21.CrossRefGoogle Scholar
  13. 13.
    Emanuel EJ, Wendler D, Grady C. What makes clinical research ethical? JAMA. 2000;283(20):2701–11.CrossRefGoogle Scholar
  14. 14.
    Freedman B. Equipoise and the ethics of clinical research. N Engl J Med. 1987;317(3):141–5.CrossRefGoogle Scholar
  15. 15.
    Childers R, Lipsett PA, Pawlik TM. Informed consent and the surgeon. J Am Coll Surg. 2009;208(4):627–34.CrossRefGoogle Scholar
  16. 16.
    Menikoff J, Kaneshiro J, Pritchard I. The common rule, updated. N Engl J Med. 2017;376(7):613–5.CrossRefGoogle Scholar
  17. 17.
    Riskin DJ, Longaker MT, Gertner M, et al. Innovation in surgery: a historical perspective. Ann Surg. 2006;244(5):686–93.CrossRefGoogle Scholar
  18. 18.
    Biffl WL, Spain DA, Reitsma AM, et al. Responsible development and application of surgical innovations: a position statement of the Society of University Surgeons. J Am Coll Surg. 2008;206(6):1204–9.CrossRefGoogle Scholar
  19. 19.
    Stewart WW, Feder N. The integrity of the scientific literature. Nature. 1987;325(6101):207–14.CrossRefGoogle Scholar
  20. 20.
    Benos DJ, Fabres J, Farmer J, et al. Ethics and scientific publication. Adv Physiol Educ. 2005;29(2):59–74.CrossRefGoogle Scholar
  21. 21.
    Steneck N. ORI introduction to the responsible conduct of research. Department of Health and Human Services. In: US Government Printing Office. Washington D.C; 2007.Google Scholar
  22. 22.
    Martinson BC, Anderson MS, de Vries R. Scientists behaving badly. Nature. 2005;435(7043):737–8.CrossRefGoogle Scholar
  23. 23.
    Sarwar U, Nicolaou M. Fraud and deceit in medical research. J Res Med Sci. 2012;17(11):1077–81.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Shamoo AE, Resnik DB. Responsible conduct of research. New York: Oxford University Press; 2015.Google Scholar
  25. 25.
    Raghav KP, Mahajan S, Yao JC, et al. From protocols to publications: a study in selective reporting of outcomes in randomized trials in oncology. J Clin Oncol. 2015;33(31):3583–90.CrossRefGoogle Scholar
  26. 26.
    Steen RG. Misinformation in the medical literature: what role do error and fraud play? J Med Ethics. 2011;37(8):498–503.CrossRefGoogle Scholar
  27. 27.
    Ioannidis JP. How to make more published research true. PLoS Med. 2014;11(10):e1001747.CrossRefGoogle Scholar
  28. 28.
    Ioannidis JP. Why most published research findings are false. PLoS Med. 2005;2(8):e124.CrossRefGoogle Scholar
  29. 29.
    Begley CG, Ioannidis JP. Reproducibility in science: improving the standard for basic and preclinical research. Circ Res. 2015;116(1):116–26.CrossRefGoogle Scholar
  30. 30.
    Casadevall A, Fang FC. Reforming science: methodological and cultural reforms. Infect Immun, Vol. 80. United States; 2012. p. 891–896.Google Scholar
  31. 31.
    Casadevall A, Ellis LM, Davies EW, et al. A framework for improving the quality of research in the biological sciences. MBio. 2016;7(4):e01256-16Google Scholar
  32. 32.
    Announcement: reducing our irreproducibility. Nature. 2012;492:34–6.Google Scholar
  33. 33.
    Kornhaber RA, McLean LM, Baber RJ. Ongoing ethical issues concerning authorship in biomedical journals: an integrative review. Int J Nanomedicine. 2015;10:4837–46.CrossRefGoogle Scholar
  34. 34.
    Lundberg GD, Glass RM. What does authorship mean in a peer-reviewed medical journal? JAMA. 1996;276(1):75.CrossRefGoogle Scholar
  35. 35.
    Thompson DF. Understanding financial conflicts of interest. N Engl J Med. 1993;329(8):573–6.CrossRefGoogle Scholar
  36. 36.
    Lo B, Field MJ. Conflict of interest in medical research, education, and practice. Institute of Medicine. Washington D.C.: The National Academies Press; 2009.Google Scholar
  37. 37.
    Freischlag JA. Academic medical centers write their own rules. J Vasc Surg. 2011;54(3 Suppl):19s–21s.CrossRefGoogle Scholar
  38. 38.
    Rosenthal MB, Mello MM. Sunlight as disinfectant--new rules on disclosure of industry payments to physicians. N Engl J Med. 2013;368(22):2052–4.CrossRefGoogle Scholar
  39. 39.
    Agrawal S, Brown D. The physician payments sunshine act--two years of the open payments program. N Engl J Med. 2016;374(10):906–9.CrossRefGoogle Scholar
  40. 40.
    Kinghorn WA. Medical education as moral formation: an Aristotelian account of medical professionalism. Perspect Biol Med. 2010;53(1):87–105.CrossRefGoogle Scholar
  41. 41.
    Markman M. Mentoring in the ethics of clinical research: an ongoing need. Curr Oncol Rep. 2007;9(4):235–6.CrossRefGoogle Scholar
  42. 42.
    Chopra V, Edelson DP, Saint S. A PIECE OF MY MIND. Mentorship malpractice. JAMA. 2016;315(14):1453–4.CrossRefGoogle Scholar
  43. 43.
    Zerzan JT, Hess R, Schur E, et al. Making the most of mentors: a guide for mentees. Acad Med. 2009;84(1):140–4.CrossRefGoogle Scholar
  44. 44.
    McCullough LB. Laying medicine open: understanding major turning points in the history of medical ethics. Kennedy Inst Ethics J. 1999;9(1):7–23.CrossRefGoogle Scholar

Suggested Reading

  1. Beecher HK. Ethics and clinical research. N Engl J Med. 1966;274(24):1354–60. Landmark report detailing multiple examples of research misconduct and violations of humans subjects rights.CrossRefGoogle Scholar
  2. Emanuel EJ, Wendler D, Grady C. What makes clinical research ethical? JAMA. 2000;283(20):2701–11. Discussion of 7 proposed requirements that comprise a framework for evaluating the ethics of clinical research studies.CrossRefGoogle Scholar
  3. Pawlik TM, Platteborze N, Souba WW. Ethics and surgical research: what should guide our behavior? J Surg Res. 1999;87(2):263–9. Discussion of the principles that anchor ethical behavior in surgical research, with the proposal that character should serve as a moral guide.CrossRefGoogle Scholar
  4. Shamoo AE, Resnik DB. Responsible conduct of research. New York: Oxford University Press; 2015. Comprehensive review of the ethical issues surrounding biomedical research. Covers multiple topics and is well supplemented with case studies.Google Scholar
  5. The nuremberg code. JAMA. 2017;276(20):1691–1. Considered among the founding documents of modern bioethics, the 10-point Nuremberg code outlines protections including informed consent and argues any research must benefit society.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryThe Ohio State University, Wexner Medical CenterColumbusUSA
  2. 2.Department of SurgeryThe Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical CenterColumbusUSA

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