Michael Pritchard Professor; Co-Director of The Ethics Center Western Michigan University Michael S. Pritchard's Commentary on Family Decision-Making about End-of-Life Care Added 3/8/2016 5:02 PM It is certainly understandable, even commendable, that those who provide palliative care consultation services would want to have a better understanding of variables that may affect the quality of care they provide. Some of this understanding will be acquired “on the job,” as one provides these services—at least by perceptive consultants. But systematic ... Read More It is certainly understandable, even commendable, that those who provide palliative care consultation services would want to have a better understanding of variables that may affect the quality of care they provide. Some of this understanding will be acquired “on the job,” as one provides these services—at least by perceptive consultants. But systematic research is likely to bring other important matters to light, challenge assumptions that might otherwise adversely affect the services offered, and so on. In short, the recipients of these services can benefit even more from consultants who effectively incorporate research results into their practice. The sort of research interests that Dr. Menendez has are consistent with her concern to provide the best services she can—and to help others do so as well. At the same time, she should have some real concerns about whether it is appropriate for her to serve as therapist and researcher for the same clientele, whether individuals or family units. The informed consent issues raised in Part II of this case illustrate why. Apparently some primary care physicians, intentionally or inadvertently, have led family members to believe that the quality of service they can expect will be adversely affected by not agreeing to participate in the study. If this worry is engendered by their primary care physician, who is not providing the therapeutic services in question, it makes good sense to suppose that the therapist/researcher could be seen as equally, if not more, threatening. Will the therapist/researcher be less interested in those patients, or their family members, who indicate they do not want to participate? The very fact that patients or family members might worry about this could have a negative affect on the therapeutic relationship they have with Dr. Menendez. So, as researcher, Dr. Menendez might restrict her research to patients and their families who are not under her care. This means that if her own patients and their families are to be participants in the sort of research project she is interested in, another researcher would be needed. There is still no assurance, of course, that the problem will be solved. Patients and their families would be informed that, in addition to consulting with their therapist, there will be someone else involved, albeit for research rather than therapeutic purposes. Will they worry that the therapist and researcher are cooperating with each other in such a way that their therapeutic services will be affected by not participating in the study? Adding a researcher to the mix may raise other patient and family concerns. Not only are they expected to discuss sensitive, private matters with a therapist, they are to be observed by a third party, a researcher with whom they have no other relationship. Aside from causing them discomfort, this might also have a negative affect on the therapeutic relationship by, say, causing them to be more reticent. If this factor cannot be ruled out, this could also affect the validity of any claims about what goes on between therapist and patient/family that they are not being observed for research purposes—whether by their therapist or a third party. There does not seem to be a sure way of totally eliminating such worries about the possible adverse affects of the research on therapeutic services, or worries about the validity of the research data itself. A point to be emphasized, however, is that special care needs to be taken in regard to informed consent. Patients and their families need assurances that participating (or not participating) in the research project will not affect the quality of services they will receive. The scenario in Part II suggests that very little, if any, monitoring of the informed consent process was done in regard to the role of the primary care physicians. At the very least, this issue should be addressed. The concern is that undue pressure might have been used on patients and their families, or that this is their perception. But the concerns do not stop there. As just pointed out, additional worries about the quality of care provided by the therapist/researcher remain, even if referring physicians handle things very well. These problems aside, Dr. Menendez, and perhaps her patients as well, would like to have full participation by both patients and family members. What if one or more of the family members express reluctance to participate, or outright refuse? Noncoercive efforts to persuade may be appropriate, although it can be very difficult to determine where to draw the line when attempting to persuade the reluctant to join with their already willing family members. The researcher already has strong allies in this circumstance, unless, of course, there is a history of significant tensions or divisions among family members. So, additional efforts to recruit family members can easily become a matter of undue pressure. Dr. Menendez may be disappointed at not gaining the consent of all patients and family members, but this need not be fatal to her project—especially if she is joined in her research efforts by other researchers, thus enlarging the potential pool of participants. Read Less
Michael Pritchard Professor; Co-Director of The Ethics Center Western Michigan University Michael S. Pritchard's Commentary on Ethical Issues in Student Research Added 3/8/2016 3:14 PM Like most institutions of higher learning, James Bower’s university holds that research done only for educational purposes does not come directly under the purview of the IRB. However, many such institutions require instructors to submit a statement to the IRB indicating the sorts of research that students will be undertaking. Although individual protocols are not submitted, ... Read More Like most institutions of higher learning, James Bower’s university holds that research done only for educational purposes does not come directly under the purview of the IRB. However, many such institutions require instructors to submit a statement to the IRB indicating the sorts of research that students will be undertaking. Although individual protocols are not submitted, this enables the IRB to provide cautionary advice about potentially problematic kinds of research that students might wish to undertake. As this case illustrates, it is possible that particular research projects undertaken only for educational purposes can nevertheless raise unanticipated, serious problems. IRBs are designed to protect the rights and welfare of human participants. However, the protection to which participants are entitled is not confined only to those areas that come directly under the purview of an IRB. What justification, then, can be given for not requiring research done only for educational purposes to be reviewed by an IRB? First, administratively, requiring every student to submit a protocol would be very time consuming and require a substantial increase in IRB staffing. Second, given the relative shortness of the standard semester, it might make it much more difficult for students to complete their research projects. Third, there may be an assumption that instructors will adequately supervise the research projects undertaken by students and not permit them to place participants at more than minimal risk of harm. So, we might be tempted to say, some sort of procedural compromise is reasonable. Nevertheless, this should not come at the expense of protecting human participants in research, whether or not this is undertaken for educational purposes only. Especially since the researchers are inexperienced undergraduates who are just “learning the ropes” in research, careful monitoring of this research is important. In this case, the instructor is a graduate student, who himself seems to be relatively inexperienced. It is disturbing that, although James is teaching under the supervision of Dr. Holden, there is no evidence that this aspect of his teaching has received any supervision. In fact, it does not seem to have occurred to James that he could consult with Dr. Holden about what sorts of research projects by his students would be acceptable. Why would James talk only with his fellow graduate students? Something seems seriously amiss here, and perhaps in the department generally, as other graduate students seem to have proceeded unsupervised as well. The fact that James does not anticipate the risks posed by his students’s depression survey indicates either his lack of experience or indifference on his part. What would Dr. Holden have advised? Had he been consulted, he might well have told James that he should not allow this sort of survey to be conducted, at least not without IRB review. A worry is that Dr. Holden might actually share the attitude of James’s fellow graduate students—if the research falls outside the purview of the IRB, don’t worry about it. Meanwhile, the survey is conducted by the undergraduate students, presumably unaware that further responsibilities may fall on their shoulders (and James’s) once they learn the results. How to proceed once they learn that there may be two students who could use professional help with their depression is a difficult issue. In an effort to preserve anonymity, James reports to the entire class that several students may be suffering from depression. “Which ones?” the students might ask. “We cannot tell you directly,” James would reply. “But if you reported more than four symptoms of depression, you should contact the university behavioral health center.” How are the students to determine how many symptoms of depression they reported? Was the survey so direct? Did it label the symptoms for the students? Is it likely that only two students will think that they have identified four or more symptoms? And will it be the right two students? Unfortunately, James probably has no experience dealing with situations like this, or even with thinking about them. One of the functions of an IRB is to help researchers anticipate such problems and settle on a good procedure for dealing with them should they arise. James has deprived himself of all access to this sort of help by failing to communicate with either his supervisor, Dr. Holden, or the IRB. However, the fact is that the survey placed undergraduate students at risk of harm. Consider this as a guiding principle: Even if you are not seeking to contribute to generalizable knowledge in your research, you still need to worry about whether your research places anyone at risk. Saying that risks to participants matter only when generalizable knowledge is sought makes no moral sense. So, risks matter even if they do not fall under the direct purview of an IRB. This seems to imply that Dr. Holden has a responsible role to play in this, but chose not to accept it, negligently ignored it, or was somehow denied the opportunity to assume it. At the very least, James should have been informed at the outset by Dr. Holden that he should be given the opportunity to review the sorts of research projects proposed by students. However, a conscientious IRB would also do its best to make all teachers, professors and graduate students alike, aware of its willingness (and desire) to address questions regarding the protection of human participants in any research involving the institution it is serving. Read Less
Michael Pritchard Professor; Co-Director of The Ethics Center Western Michigan University Responding to disasters like Katrina Added 9/16/2010 10:13 AM This is a good question, but a complex one. In general, I'd say that Fred Cuny's basic approach includes trying to be prepared to act quickly and effectively before a disaster strikes. The problem is that it seems they we are so often taken by surprise. In the case of Katrina, hindsight might have told us that the levees put the area at high risk for bad things if they don't hold. And, it seems ... Read More This is a good question, but a complex one. In general, I'd say that Fred Cuny's basic approach includes trying to be prepared to act quickly and effectively before a disaster strikes. The problem is that it seems they we are so often taken by surprise. In the case of Katrina, hindsight might have told us that the levees put the area at high risk for bad things if they don't hold. And, it seems to me, there were engineers who had issued warnings about their inadequacy. Still, was anyone in a good position to anticipate the magnitude of the disaster that could result from their failure? Well, suppose that, realistically, we should always expect that sometime or other, some way or other, we will be taken by surprise in disastrous ways--even with our best efforts to take preventive measures. Once disaster strikes, Cuny would say that engineers will be needed. His book on disaster relief (Oxfam/Oxford) focuses mainly on how best to help after disaster strikes. This, he says, requires one to figure out both how to provide assistance & knowledge of what will really count as (long-term) assistance. This latter knowledge, he says, requires knowing how those who are victims see things, what they will be able to do for themselves once the rescuers leave, and so on. For Cuny, quick fixes are like bandaids--something that may be needed in the short run (to keep the bleeding under control). But Cuny was interested in long-term fixes. An understanding of local needs, abilities, etc. is something that one could try to acquire well before disaster strikes. This is because the understanding that is needed is not just of rescue tactics, but of what a community needs when things are going well (after the rescuers have left). I can't do justice to what Cuny had in mind in short space (after all, he wrote an entire book on this). But it seems that, ideally, good rescue work after disaster strikes requires leadership that is well informed about the life conditions (past, present, and future) of those who might be victimized by disasters (a disproportionate number of whom, unfortunately, typically are already living in poverty, neglect, or in oppressive circumstances). In any case, more than specialized engineering knowledge is needed & there needs to be a readiness to learn about these other matters of importance (as it is unlikely that even someone as conscientious as Cuny would have all the needed knowledge ready-to-hand). Formal, interdisciplinary education may well have a role to play here. So, what kind of "corporate backing" might be most useful in light of Cuny's approach? Not money for bandaids only, he might have said. Money for educational programs designed to prepare engineers to do effective disaster relief work as engineers might be a good investment. Cuny and his disaster relief agency should not be the exception (as they have been perceived by many, including themselves, to be); they should be more commonplace in the engineering professions. The corporate challenge, then, could be to encourage and support engineering programs that can be expected to give us more engineers who will be ready and able to respond constructively to disasters like Katrina. At the same time, this sort of program could focus on the need for preventive measures, or at least measures likely to reduce the impact of Katrina-like disasters. I hope these comments are at least a little bit helpful, belated and broad as they are. Read Less
Michael Pritchard Professor; Co-Director of The Ethics Center Western Michigan University Michael S. Pritchard's Commentary on "Who can change Proprietary Source Code" Added 8/17/2006 9:54 AM It might seem that this case is basically about law rather than ethics. Clearly it does raise a number of legal questions. However, there is a strong ethical dimension as well. Derek's desire to adapt the software program to his new job circumstances seems innocent enough. But the fact that his new employer required him to sign a software agreement that what he designs ... Read More It might seem that this case is basically about law rather than ethics. Clearly it does raise a number of legal questions. However, there is a strong ethical dimension as well. Derek's desire to adapt the software program to his new job circumstances seems innocent enough. But the fact that his new employer required him to sign a software agreement that what he designs becomes company property should have alerted him to a potential problem. Although Derek did not sign a similar agreement with his previous employer, this does not conclusively settle the question of ownership. Others were involved in the initial design. At the very least, Derek should have inquired about the ownership matter prior to adapting the software to his purposes. This would not only protect his current employer from a potential law suit (should the previous employer choose to sue), it would also evidence respect for the interests of his previous associates. Carelessly placing one's employer at legal risk is both an ethical and a legal concern. Indifference to the interests of his previous associates is an ethical concern, unless we can assume that Derek is estranged from them (and even if he is, there might have been an implicit understanding about the disposition of the software). After all, Derek is very possibly legally entangling the "lifeblood" of his previous employer, given his current employer's apparent desire to claim ownership of its employees' software designs. It might be objected that Derek did not know that his new employer would use all means at its disposal to adapt the software system throughout the company. True, but his having to sign an ownership agreement should have put him on alert. It seems clear from the case that Derek bore no special animosity against his previous employer and associates. Now, to his regret, he has become involved a legal and ethical quagmire. Perhaps a careful investigation of law can clarify the legal rights involved in this case, but the ethical concerns cannot be handled so readily. So, I conclude that Derek should have proceeded with greater caution, heeding the concerns of Horace. A call to his previous employer before adapting the system might have avoided these problems. Read Less
Michael Pritchard Professor; Co-Director of The Ethics Center Western Michigan University Commentary: The Slave Driver vs. the Lazy Student Added 4/20/2006 2:07 PM Michael S. Pritchard Western Michigan University Are Santiago's standards unreasonable? Is Patton's work ethic lacking? It is difficult to answer these questions without further probing. Apparently, Santiago and Patton would answer each of these questions differently. Santiago: "My standards are reasonable; Patton needs to work harder." Patton: "Santiago's standards are ... Read More Michael S. Pritchard Western Michigan University Are Santiago's standards unreasonable? Is Patton's work ethic lacking? It is difficult to answer these questions without further probing. Apparently, Santiago and Patton would answer each of these questions differently. Santiago: "My standards are reasonable; Patton needs to work harder." Patton: "Santiago's standards are unreasonable. It shouldn't take me another couple of years to have a publishable paper; my work ethic is fine." Two strategies might help resolve these differences. First, a conversation between Santiago and Patton, in which they actually discuss their differences, might be helpful. The case presents no evidence of their having such a conversation. However, for this conversation to be helpful, it cannot simply be a confrontational meeting. Santiago questions Patton's dedication (too many vacations and extracurricular activities). Patton questions Santiago's motivation (she wants Patton around longer as an assistant because she does not seem able to recruit new assistants). If Santiago is right, Patton has little basis for complaint. If Patton is right, Santiago is exploiting Patton. A meeting in which they confront each other with their suspicions is unlikely to help them move ahead constructively (at least not together). However, a meeting in which they seek a meeting of minds on how Patton might best complete her degree program could have good results and might even dissolve their mutual suspicions. Second, at this point Patton's thesis committee is involved; perhaps committee members can play a mediating role. The committee is convinced that Patton is a strong candidate. Perhaps a meeting involving Patton, Santiago and at least one other member of the committee could help put a more constructive spin on the situation. Given their mutual suspicions, Patton and Santiago may not be able to move ahead without the mediation of others. How could an institution prevent such situations? How can a department or institution encourage good adviser/student relationships? As long as the basic communication about expectations and requirements is only one-to-one (adviser to advisee), such situations can easily occur. Meetings and workshops on program aims and requirements can help promote understanding among faculty and students alike. When students and faculty are left on their own to work out these matters one-on-one, it should be no surprise to find misunderstandings and suspicions. Does the department have any say about what reasonable standards are? Is there any discussion about how best to help students meet these standards? Are there candid discussions with students about how much work it takes to complete a program in a timely fashion? Are students fully informed about the publication restraints that accompany industrial collaboration? What are Santiago's obligations to her students' careers? I prefer to phrase this question somewhat differently: What are Santiago's obligations to help her students in the course of their degree programs? I would tie these obligations to the institution in which she is working, the quality of program her department is seeking to maintain, and the institution's and department's obligations to its students generally. Within that framework, Santiago has an obligation to provide opportunities and encouragement for Patton to do the best work she can. If Santiago does not want to publish Patton's work because she feels it will not benefit her own career, she seems to have things the wrong way around. Santiago's basic question should be whether her standards are reasonable (and not just in her own eyes, but from the standpoint of her department), and whether Patton is satisfying them. If the bar is too high for Patton, what should be done? Perhaps the bar should be lowered. But departmental standards are for all students, not just for Patton. The question of reasonable standards should not be settled by Santiago alone, Patton alone or even Santiago and Patton together. Again, it is important that others be involved in the issue between Santiago and Patton. What about the relevance of industrial collaboration to Santiago and Patton's work? It is difficult to answer this question in the abstract. Certainly is it possible for researchers to become involved in industrial collaboration in ways that compromise their commitments to the university and/or their students. However, that problem does not require outright refusal to become involved in such collaborations. At the same time, students need to be fully informed about the limitations that will be placed on their own research should they join in such collaborations - and they should be informed about the implications of collaborative research before they agree to participate. From: Graduate Research Ethics: Cases and Commentaries - Volume 5, 2001 edited by Brian Schrag Read Less