1. Chapter 12: Ethical and Legal Issues in Epidemiology

2. Introduction
Question of ethics arises when our conscience and thoughts fail to agree.
Greatest unethical disasters have happened because of discrimination.
Based on race, gender, color, accent, religion, citizenship
Unethical incidences continue to occur.

3. Unforgivable History of Humans
Torture and experimentation carried out by Nazis let to development of Nuremberg Code.
Nuremberg Code failed to prevent some unethical studies since.
Secret radiation experiments carried out by federal agencies
Testing of drugs by drug companies in one country for use in another country

4. World Medical Association Declaration of Helsinki
Developed in 1964
Protects rights of humans involved in medical research
Research must be conducted for either diagnostic or therapeutic benefits
Principles are regularly reviewed and updated

5. Belmont Report Principles applying to research subjects:
Respect for persons
Includes concepts of autonomy and protection from diminished autonomy
Beneficence
Includes concepts of do not harm and maximize the benefits
Justice
Includes concept of fairness

6. Third World as a Scapegoat
Drug companies conduct studies in Africa that breach the Declaration of Helsinki.
High incidence of HIV and of poverty attracts studies.
Outmoded ways of dealing with public health continue, such as chlorinating water to contain spread of cholera.
Outbreaks have become infrequent, and chlorine causes bladder cancer.

7. Ethical Issues Associated With Genetic Testing
Informed consent
Confidentiality
Privacy
Discrimination

8. Ethical Issues Associated With Public Health Data
Electronic medical records contain private information.
May be disclosed in some circumstances.
Can even leak out through hard drives on recycled photocopy machines .
In some countries health care is controlled by the government.

9. Honorary Coauthorship
Pressed by some department heads in academia and healthcare facilities on junior faculty and researchers
Difficult to deal with
Research has shown that the quality of research is diluted.

10. Cyberspace Research and Ethical Dilemmas
Informed consent without face-to-face contact
Accuracy of the information gathered
Technological issues
Access to identifications
Biases associated with qualitative research

11. Ethical Issues With Research Involving the Elderly
Informed consent process is interfered with by:
Confusion
Dementia
Cultural issues
Privacy may be violated.
Institutional review boards should protect elderly from harm and abuse.

12. Controversial Public Health Issues
Autism was incorrectly linked to MMR vaccine through a non-scientific study.
Negatively impacted autistic children’s health by increasing susceptibility to deadly viruses
Quarantine
Applied to some diseases
Nurses should understand its limits and consequences.

13. Traumatic Experience of Natural Disasters
Decisions made by public health professionals during disaster should be based on principles of:
Autonomy
Beneficence
Justice
2010 Gulf of Mexico oil spill
Large, unfortunate opportunity to study effects of a disaster

14. Resources for Public Health Ethics
With your research studies:
Understand global impacts of research question.
Address ethical and legal questions associated with study.
Honor the public trust placed in you.
The textbook lists some available resources on ethical issues.

15. Legal Epidemiology
Epidemiologists play important role in identifying evidence of causation in legal issues.
Statistically significant studies may help legal decision-making process.
Epidemiological study conclusions can be misused.