24 - Landmark studies relevant for critique on eth

Landmark studies relevant for critique on ethics

© SPMM Course  Declaration of Geneva 1948: Reaffirmation of humanitarian aims of medicine by World Medical Association. The Declaration of Geneva is a modification of Hippocratic Oath, intended to highlight the dedication of medical profession for the cause of humanitarian goals.  Declaration of Helsinki 1964: This was adopted by The 18th World Medical Association General Assembly in 1964 and has been amended five times since, most recently in 2000. Notes of clarification were added in 2002 and 2004. The current (2004) version is the only official one. The Declaration specifically addresses clinical research, reflecting changes in medical practice from the term 'Human Experimentation' used in the Nuremberg Code. Landmark studies relevant for critique on ethics Tuskegee Syphilis Study (1932-1972): Between 1932 and 1972, US public health service followed up nearly six hundred low-income African-American males, 400 of whom were infected with syphilis. All diseased subjects were periodically examined but were not informed of the disease that they were diagnosed with and the implications of such diagnosis, even after the introduction of penicillin in 1950s. In some cases, when other physicians diagnosed subjects as having syphilis, researchers intervened to prevent treatment, in order to study the natural course of syphilis. Many subjects died of syphilis during the study. The study was strongly criticized, and US government issued a public apology in 1997. As a result of this Belmont Report was produced. Important principles outlined:

1. Respect for persons i.e. Individuals should be treated as autonomous agents and those with diminished autonomy should be adequately protected for research purposes.
2. Informed consent should be obtained by providing full information, ensuring comprehension and maintaining voluntariness (can withdraw at any time).
3. During a research, beneficial effects must outweigh any harms caused, with a systematic assessment of benefits and risks carried out beforehand. Willowbrook School Study (1963 - 1966): Mentally handicapped children at Willowbrook State School were deliberately infected with hepatitis after parents gave consent for what they thought to be vaccinations. The study was looking at the course of hepatitis and effectiveness of viral inoculation. There is evidence to suggest only consenting families were admitted to the school. Jewish Chronic Disease Hospital: Studies to develop information about the nature of human transplant rejection. Chronically ill patients who did not have cancer where unknowingly injected with cancerous human liver cells. The defense argued that the administration did not want to scare patients and expected the cells to be rejected.

© SPMM Course Tearoom Trade Study: During 1960s, a sociologist called Laud Humphries followed up many men who had anonymous sex in public places by tracing their number plates after falsely befriending them. The research was conducted without explicit informed consent and became a matter of debate, highlighting the important of ethics in scientific research in non-medical fields of enquiry.

DISCLAIMER: This material is developed from various revision notes assembled while preparing for MRCPsych exams. The content is periodically updated with excerpts from various published sources including peer-reviewed journals, websites, patient information leaflets and books. These sources are cited and acknowledged wherever possible; due to the structure of this material, acknowledgments have not been possible for every passage/fact that is common knowledge in psychiatry. We do not check the accuracy of drug-related information using external sources; no part of these notes should be used as prescribing information

© SPMM Course Notes prepared using excerpts from:  Angermeyer MC, Matschinger H. The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder. Acta Psychiatr Scand 2003; 108:304–309.  Bebbington & Kuipers, 2003. Schizophrenia and psychosocial stresses. In Schizophrenia, Hirsch & Weinberger (Ed). Blackwell; Oxford.  Benbow, A. (2007) Mental Illness, stigma and the media. Journal of clinical psychiatry, 6; supp 2: 31 – 35  Bhugra & Gupta: Medical professionalism in psychiatry. Advances in Psychiatric Treatment (2010) 16: 10-13 http://apt.rcpsych.org/content/16/1/10.full  Bhui, K & Bhugra D. Communication with patients from other cultures: the place of explanatory models. Advances in Psychiatric Treatment 2004, 10 (6) 474-478;  Boyer, BA. & Paharia, MI. (Ed) Comprehensive Handbook of Clinical Health Psychology. 2008. John Wiley & Sons; NewYork  Chapter on Sociology and Psychiatry. Companion to psychiatric studies. 6th ed.  Cooper, B. Immigration and schizophrenia; the social causation hypothesis revisited. British Journal of Psychiatry (2005) 186: 361-36  Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry 2002; 1: 6– 20.  Crisp, A. H., et al (2004) The College’s Anti-Stigma Campaign, 1998–2003: a shortened version of the concluding report. Psychiatric Bulletin, 28, 133 –136.  Curson DA, et al. Institutionalism and schizophrenia 30 years on. Clinical poverty and the social environment in three British mental hospitals in 1960 compared with a fourth in 1990. British Journal of Psychiatry 1992; 160: 230-241.  Galea et al. The Social Epidemiology of Substance Use. Epidemiol Rev 2004;26:36–52  Hashemi, A. H. & Cochrane, R. (1999) Expressed emotion and schizophrenia: a review of studies across cultures. International Review of Psychiatry, 11, 219–224  http://www.medschools.ac.uk/  Jorm AF, Korten AE, et al. Helpfulness of interventions for mental disorders: beliefs of health professionals compared with the general public. Br J Psychiatry 1997; 171: 233-237  Kendler, KS et al. Life Event Dimensions of Loss, Humiliation, Entrapment, and Danger in the Prediction of Onsets of Major Depression and Generalized Anxiety. Arch Gen Psychiatry. 2003; 60(8):789-796.  Kendler, KS et al. Stressful life events and genetic liability to major depression: genetic control of exposure to the environment? Psychological Medicine (1997), 27: 539-547  Link et al. Measuring Mental Illness Stigma Schizophrenia Bulletin, Vol. 30, No. 3, 2004. 30 (3): 511. (2004)  Morriss & Morriss. Contextual evaluation of social adversity in management of depressive disorder. Advances in Psychiatric treatment. 2000, 6, pp. 423–431  Muntaner C et al. Socioeconomic Position and Major Mental Disorders. Epidemiol Rev (2004) 26 (1): 53-62.  Peele et al. (1977). Asylums revisited. American Journal of Psychiatry, 134: 1077-81.  Weindling, P.J. (2005). Nazi Medicine and the Nuremberg Trials: From Medical War Crimes to Informed Consent. Palgrave Macmillan.  WMA Medical Ethics Manual. Last Accessed on 30 Jan 2015 at http://www.wma.net/en/70education/30print/10medical_ethics/