Sarana Alexander New York City College of Technology Nursing Research NUR 3130-8516 Spring 2012
1)
Journal Article: Conducing Research with the Elderly: Ethical Concerns for a Vulnerable population.
Keywords: Nursing Research, Elderly, Ethics
Database Used: Medline with full text
Number of Hits: 10
2)
Journal Article: Ethical Issues Involving Research Conducted With Homebound Older Adults.
Keywords: Nursing Research, Elderly, Ethics
Database Used: PubMed
Number of Hits: 45
“Ethical principles guiding a person’s participation in research have evolved substantially over the last 50 years, with special considerations for groups identified as vulnerable”. (Walsh, 2010) Different types of studies which include medical, psychological and social research are conducted with the elderly population, in an effort to gather facts, gain further understanding and knowledge about diseases and to find solution to problems.
According to the NBAC (National Bioethics Advisory Council), vulnerability is context-specific and can be related to cognitive and communicative vulnerability. (Walsh, 2010) “A vulnerable population may be at risk due to age, health, functional status, chronic or terminal illness, inability to effectively communicate, or financial circumstances, all of which may apply to the elderly.” (Walsh, 2010) The older population is considered to be between the ages of 65 and older and there are numerous aspects of aging that can cause people to be at risk for ethical problems in research.
The Article, “Conducting research with the elderly: ethical concerns for a vulnerable population”, reviews concepts of autonomy, beneficence, and justice related to elderly research. “The purpose of the study was to identify and discuss ethical risks unique to the elderly population and propose solutions through the use of case studies”. (Walsh, 2010) The greatest indicator of vulnerability for the elderly as highlighted in this article is; lack of social support. It is further explained that due to lack of support the elderly may encounter feelings of powerlessness and as a result engage in studies not because of the will to participate, but because he or she feels powerless to resist.
There are many studies in which inhuman acts were performed under the excuse of medical research; hence the reason why an ethical code of conduct was established to ensure voluntary consent and avoidance of harm to participants of studies.
The second article I selected was, Ethical issues involving research conducted with homebound older adults which addresses the ethical challenges that necessitate concern when conducting research with older adults. In this article homebound older adults are defined as people who can’t leave their homes unassisted because it takes considerable effort to do so.
Both articles make reference to an ethical code of conduct known as the Belmont Report (principles of respect for persons, beneficence, and justice), which was created in response to studies such as the, “Tuskegee Syphilis Study”, that denied black men effective treatment to syphilis. The Belmont Report represented the commission’s work which delineated the boundaries of biomedical and behavioral research, assessing risk/benefit, guidelines for the selection of subjects, and the constitution of informed consent in diverse situations. Policy makers around the globe have adopted the principles laid out in the report”. (Walsh, 2010)
The articles also specify the three principles articulated in the Belmont Report which is respect for persons, beneficence and justice. Individuals should be recognized as autonomous unless he or she does not have the ability for self-determination, in which case, the individual is entitled to protection (hence the term Protected/vulnerable groups). The well-being of participants should be ensured, benefits maximized with no harm inflicted and all participants should be treated fairly. (Walsh, 2010)
There were three case studies presented in the article by Walsh (2010). The second case study really enhanced my understanding of ethical dilemmas in research of elderly participants. It dealt with ethical issues related to dependent, chronically ill (frail) elderly with loss of independence making them a vulnerable group. The elderly involved in this study was a 76 year old African American woman, homebound with osteoarthritis, living alone and receiving daily hot meals from a social service. Her primary physician, who owns stock in the drug company, suggested her enrollment in a 6 months study for a new medication to treat arthritis. A research assistant went to her home to provide information, answer questions, and provide brochures about the study. A consent form was left with the participant and the research assistant got the signed form when he returned several weeks later.
This article scrutinized the ethical issues prevalent in the case study which included conflict of interest, feelings of being threatened because she may have felt that her current services such as meals may be declined, which in turn affected her ability to choose freely. “Perhaps in eagerness for a change of routine and fellowship, she simply signed the consent and overlooked the risks. In addition, her comprehension of the study presentation was never assessed.” (Walsh, 2010)
The article, Ethical issues involving research conducted with homebound older adults; researchers studying homebound older adults described the methodological issues (recruitment of homebound participants) that make studying homebound older adults especially vulnerable to therapeutic misconception and researcher role conflict. (Locher, Bronstein, Robinson, Williams, Ritchie, 2006) Clear communication during the inform consent process along with scientific communication with colleagues are two suggestions made in this article to prevent ethical dilemmas.
This article mentioned that participants for elderly research are usually obtained through referrals from home health agencies, which poses an ethical issue since participants are more willing to take part in a study that is referred by their health care provider. (Locher, Bronstein, Robinson, Williams, Ritchie, 2006). For instance, a participant will be influenced by a nurses recommendation to participate in a study because of the trusting relationship or dependency that person has with the nurse. This is a problem since the participant will not even look at the risk/benefit of the study before agreeing to participate.
Both articles highlight that older adults participate in studies because of loneliness, lack of social contact and the belief that if they participate, they will get better access to health care from their health care providers who referred them to enroll in the study. Basically, the ethical issue here is coercion of participants during recruitment which prevents obtaining consent voluntarily.
In order to prevent ethical dilemmas, researchers must protect participants’ privacy and prevent harm and consult with an Internal Review Board if they are unsure of what constitutes and ethical problem. (Locher, Bronstein, Robinson, Williams, Ritchie, 2006)
According to Essentials of Nursing Research, “there are research problems in which participants rights and study demands are put in direct conflict, posing ethical dilemmas for researchers. Such violations of ethical principles is not specifically done to be cruel but more typically occurs out of conviction that knowledge is important and potentially lifesaving or beneficial in the long run. However, researchers must develop the highest quality evidence for practice using the best methods and also adhere to rules for protecting human rights.” (Polit & Beck 2009)
REFERENCES:
Locher, J., Bronstein, J., Robinson, C., Williams, C., Ritchie, C., (2006, April). Ethical Issues involving research conducted with homebound older adults. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/
Polit, D. & Beck, C. T. (2009). Essential of nursing research: Appraising evidence for nursing practice (7 ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Walsh, SA., (2009). Conducting research with the elderly, ethical concerns for a vulnerable population. Retrieved from http://search.ebscohost.com/login.aspx?direct
