http://www.bmj.com/cgi/eletters/338/may14_1/b1972#213695 <http://www.bm/>
.......................................................................................................................................................................
<[log in to unmask]>
*BMJ Masterclass for GPs: Musculoskeletal Medicine*
Monday 5 October 2009, Birmingham
Register<http://masterclasses.bmj.com/GPs/musculoskeletal-medicine/birmingham>by
Friday 22 May and save up to £30!
*Sponsored by BMJ Group*
[image: BMJ] <http://urlblockederror.aspx/>
*Thursday
14 May 2009* Editor's Choice Rules of conscience
*Fiona Godlee*, *editor, BMJ*
[log in to unmask]
How often this week have we heard the phrase "but I was only following the
rules" as details of MPs’ expense claims were splashed across the media?
They may have been following the rules but we expected something better:
that they would follow their consciences.
Just obeying the rules has long been insufficient for doctors. The judges at
Nuremberg made clear that obeying commands from superiors didn’t remove
personal accountability. Doctors couldn’t deviate from their ethical
obligations even if a country’s laws allowed or demanded otherwise. The
World Medical Association is meeting as I write. Its most noteworthy
contribution
has been the drafting of the Helsinki Declaration on Ethical Principles for
Medical Research Involving Human Subjects. Both this and the World Medical
Association’s International Code of Ethics contain the crucial statement
that a doctor’s or investigator’s conscience and duty of care must
transcend national
laws.
So deeply ingrained is this ethic in health care that it’s surprising, even
shocking, to find that the same code isn’t shared by psychologists, at least
in the United States. As Kenneth Pope and Thomas Gutheil explain (doi:
10.1136/bmj.b1653 <http://urlblockederror.aspx/>), the American
Psychological Association has taken a series of decisions in recent years
that seem more about politics than professionalism and have put
psychologists seriously at odds with other health professions. After the
9/11 attacks, the APA changed its ethics code to allow members to set aside
ethical responsibilities if the law requires them to do so. And in 2005 the
APA agreed to allow members to take part in the interrogation of
detainees, something
that is rightly forbidden by medical associations.
Some won’t be shocked. They will agree with the APA that psychologists don’t
have the same duty of care as doctors and that their skills can be usefully
applied to developing and monitoring interrogation techniques. After all,
the APA calls interrogation "a psychological endeavour". Recent
disclosures have
shown that psychologists helped to develop methods that the Red Cross has
called "tantamount to torture".
As Pope and Gutheil explain, the APA has squared its collective conscience
by excluding detainees from its list of vulnerable groups, which includes
people with diminished capacity to consent, research participants,
subordinates, and employees. One ethicist I spoke to was reminded of how
German doctors, who before the second world war had the most enlightened
rules on the protection of humans involved in research, classified Jews and
other detainees as non-human and therefore not eligible for ethical
protection.
Ethical standards are also being fudged at the US Food and Drug Administration.
As Michael Goodyear and colleagues explain
(doi:10.1136/bmj.b1559<http://urlblockederror.aspx/>
), trials performed outside the United States will no longer have to conform
to the Helsinki Declaration even though they will be used to support
licensing of drugs in the United States. Instead they will be regulated by
the Good Clinical Practice guidelines: not an aspirational ethical code but
a manual describing existing procedure for industry sponsored trials. This
double standard could give the impression that the FDA "is more interested in
facilitating research than respecting the rights of people who are subjects
of research".
*Cite this as:* *BMJ* 2009;338:b1972
Providing you a great daily online experience.
At bmj.com <http://www.bmj.com/> you can read the latest news, comment,
research and practice articles, listen to weekly podcasts, watch videos
linked to studies, or simply search for past content.
Subscribe <http://group.bmj.com/group/subscriptions-and-sales/2009-prices>
today and make the most of BMJ.
*Sponsored by BMJ Group*
**********************************************************************
___________________________________
COMMUNITYPSYCHUK - The discussion list for community psychology in the UK.
To unsubscribe or to change your details visit the website:
http://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=COMMUNITYPSYCHUK
For any problems or queries, contact the list moderator: Grant Jeffrey ([log in to unmask])
