To better understand the available publications addressing ethical issues in rural health care we sought to identify the ethics literature that specifically focuses on rural America. We wanted to determine the extent to which the rural ethics literature was distributed between general commentaries, descriptive summaries of research, and original research publications. We identified 55 publications that specifically and substantively addressed rural health care ethics, published between 1966 and 2004. Only 7 (13%) of these publications were original research articles while (12) (...) 22% were descriptive summaries of research and 36 (65%) were general commentaries. The majority of publications examined (55%) were clinically focused while 27% addressed organizational ethics and 18% addressed ethical ramifications of rural health care policy at a national or community level. Our findings indicate that there are a limited number of publications focusing on rural health care ethics, suggesting a need for scholars and researchers to more rigorously address rural ethics issues. (shrink)

The movement in bioethics toward disclosure of financial conflicts of interest is well and good, most of the time. But in some cases, disclosure is not only unnecessary but destructive. When bioethicists advance arguments whose premises and logical moves are open to scrutiny, disclosure—far from clearing the air of bias—introduces bias.

Although bioethics consultation has always drawn the ire of critics, its extension into areas such as paid consultation with private industry has raised new concerns. Critics of consulting relationships with industry question the sincerity of for-profit corporations who seek ethical advice, alleging that a desire for improved public relations is a primary motivation of these corporations. They also question whether compensation for ethical advice creates insuperable conflicts of interest that bias the work produced. The decision of two influential professional societies (...) to establish a joint task force to examine bioethics consultation with industry reflects the seriousness of these and other concerns about this practice. The report of this task force, although controversial, has stimulated broad discussion about the ethical commitments of bioethicists and highlighted the need for clearer professional standards of conduct. (shrink)

Clinical ethical consultants are subject to an unavoidable conflict of interest. Their work requires that they be independent, but incentives attached to their role chip relentlessly at independence. This that they be independent, is a problem without any solution, but it can at least be ameliorated through careful management.

Bioethicists recognize the conflicts of interest that can arise for clinicians and scientists. However, few scholars exploring the moral dimensions of medicine and the sciences publicly address potential conflicts of interest concerning their own research. Increasingly, however, bioethicists will be confronted with difficult choices in which opportunities to obtain funding will sometimes conflict with the pursuit of critical, rigorous scholarship conducted without regard for corporate interests.

Bioethics, once a four-letter word in the private sector, is now an integral part of the decisionmaking process of biotechnology and pharmaceutical companies. And bioethicists, once confined to the classroom and limited to abstract, philosophical discussions about what is right and wrong in medicine and medical research, now play an important role in the practical implementation of ethical boundaries. Bioethicists increasingly are hired by biomedical companies as consultants to highlight and help resolve complex ethical issues that arise in the companies’ (...) normal business practices. Whether motivated by profit, reputation, or a genuine desire to act morally, these companies are willing to pay bioethicists substantial consultation fees for their “expert” opinions. This fairly recent phenomenon has caused some to be concerned about the potential for bioethicists to encounter conflicts of interests. Specifically, many critics of this new relationship between bioethicists and the private sector “are concerned about the appropriateness of ethicists who should have broader interests, such as concerns about social justice, serving clients whose primary interest is profit-maximizing.”. (shrink)

In a recent issue of The Lancet, the historian Roger Cooter predicted that the field of bioethics will soon die of self-inflicted wounds. “Conspiring against it,” he wrote, “is exposure of the funding of some of its US centres by pharmaceutical companies; exclusion of alternative perspectives from the social sciences; retention of narrow analytical notions of ethics in the face of popular expression and academic respect for the place of emotions; divisions within the discipline ; and collusion with, and appropriation (...) by, clinical medicine.” Cooter's prognosis? “Hardly wet behind the ears, bioethics seems destined for a short lifespan.”. (shrink)

As in science, so in bioethics: if prohibiting conflicts of interest is not feasible, rigorous requirements for disclosure can at least manage them.

Pharmaceutical companies are major sponsors of biomedical research. Most scholars and policymakers focus their attention on government and academic oversight activities, however. In this article, I consider the role of pharmaceutical companies’ internal ethics statements in guiding decisions about corporate research and development (R&D). I review materials from drug company websites and contributions from the business and medical ethics literature that address ethical responsibilities of businesses in general and pharmaceutical companies in particular. I discuss positive and negative uses of pharmaceutical (...) companies’ ethics materials and describe shortcomings in the companies’ existing ethics programs. To guide employees and reassure outsiders, companies must add rigor, independence, and transparency to their R&D ethics programs. (shrink)