Stand upright

Posted on Mar 9, 2012 by Leslie Gelling in Ethics

William R. LaFleur begins his book, entitled ‘Dark medicine: rationalizing unethical medical research’, by reminding us of Marcus Aurelius’ thoughts on how professionals should behave. Marcus Aurelius, Emperor of Rome between 161 and 180 AD, wrote that professionals should ‘be upright, not kept upright’. So why is it that our current approach to ethical and governance review appears to be driven by the need to keep researchers – research nurses included – upright? Are researchers not able to keep themselves upright?

The answer to these questions would appear to be straight forward. History has repeatedly demonstrated what happens when researchers are left to keep themselves upright without external and independent scrutiny. History is littered with examples of unethical research resulting in harm, even pain and suffering, and you will probably have already thought of an example. Unfortunately, repeated attempts to help researchers remain upright have not always been successful. The standout examples of unethical research and the resulting suffering were recounted at the Nuremberg Trials after the Second World War. As a result the ‘Nuremberg Code’ (1947) and later the ‘Declaration of Helsinki’ (1964 but most recently updated in 2008) were published in an attempt to prevent such events from happening again; to provide a crutch to help researchers stay upright.

Health care professionals and researchers, including research nurses, largely have the public’s confidence because of the mechanisms in place to ensure that they are kept ‘upright’ and that they always behave as society would expect them to behave. Researchers might not always like these mechanisms but without them the risks would be considerable.

Have we now gone too far in seeking to protect the minority who might be put at risk by the very small number of unscrupulous researchers? The burden placed on researchers before they can even begin their research is immense and can be both time-consuming and costly. What is not clear is what the world of research and health care would look like if we once again allowed researchers to hold themselves upright. Would research into cancer, motor neurone disease and diabetes be much more advanced? Unfortunately, reports in the media and medical press repeatedly demonstrate that unethical research continues despite the stringent ethical and governance review processes currently in place. Without these review processes, the volume of unethical research would probably increase and the potential for harm would also rise. Like it or not, it would be dangerous to assume that researchers can always hold themselves upright.

The vast majority of researchers are trustworthy and would never consider doing anything unethical that might result in harm to those involved in their research. It would be extremely foolish to suggest otherwise. It does, however, take only one example of unethical research to put the spotlight on all those involved in research.