Ethics and medical research

Press, 31 March 1989, Page 8

Ethics and medical research

The new guidelines advanced by' the Department of Health for the ethics committees of hospital and area health boards are a clear response to the Cartwright report on the treatment of certain patients at National Women’s Hospital. The situation disclosed by the report was appalling both medically and as an example of attitudes that should be outdated. But well-intentioned as the guidelines are, they are seriously deficient in some respects and the system suggested does not appear to have the financial backing needed to make it work.

Approval for any research project will be required’from an ethics committee,, blit it is not at all clear how the ethics committees will be able to function. Local ethics committees have existed for a long time; the guidelines.are an attempt to create, national standards for the local committees. V The objectives for the ethics committee seem worthy enough: to ensure the ethical aspects of treatment protocols are adequately considered; to assure the rights of the subjects of research and protect them from harm; to assure the public that this is being done; to foster the awareness of ethical principles within the service delivery units of the hoospital or area health board;, and sweepingly, “to consider any matter of ethics relevant to the board’s role under the Hospital and Area Health Boards Acts.” The ethics committees have to encompass a minimum range of expertise: ethical, medical or scientific understanding of health research, nursing experience, a Maori perspective, patient advocacy (a patient advocate is to be a member of the ethics committee), and .a,!'" -women’s health perspective. , p ' ' The deficiency in the guidelines is that nowhere is the point made that * medical research es an. admirable — and necessary — part of the make-up of any modern State and that if it is neglected then progress will stop.

It might have been expected that after the events at National Women’s the emphasis would have been given to patient rights and to establishing clearly that informed consent should govern the relationship between a doctor and a patient. What is astonishing is that the national standards for ethics committees make no mention at all of the value of medical research. Anyone chosen to serve on the committees and examining the standards is likely to get the impression that what is mainly expected is merely a watchdog role on behalf of patients. There is a profound ethical question involved in ignoring any opportunity to make life better medically.

A further problem lies in the funding of the committees. If the committees are going g to take their work seriously, they will need to meet frequently and substantial demands will be made on the time of the committee members. There is, so far, little evidence that adequate funding will be given to the committees. It will thus be difficult for the committees to acquire anything but a rudimentary knowledge of ethical subjects, which are notoriously difficult even after exhaustive study.

Of course no-one wants to be a guinea pig in a bizarre experiment, especially without having much idea about what is going on. But it is improbable that such experimentation would take place in New Zealand after the Cartwright report. What bothers many people about the practice of medicine is not mishandled research but some wellestablished procedures. The careless advocacy of, say, a hysterectomy, or an unwillingness to inform a patient about the side effects of a drug, or needlessly induced births are of greater moment to many people than objectionable ways of accumulating information or of testing an hypothesis. Experimental work needs to be monitored and evaluated. It needs to be encouraged. The standards outlined are discouraging.