Sunday, March 8, 2009

Ethics in Time of Financial Crisis

Nancy Walton, lead author for the Research Ethics Blog had an excellent post yesterday about "Ethics on the chopping block." She reports on proposals to end ethics program at the University of Memphis in Tennessee and in New Zealand, and argues - correctly I believe - that ethics programs are more important during a financial crisis, not less.

Here's her key conclusion:
Ethics review boards, in either academic or medical settings, should be doing more than reviewing protocols, providing approvals and monitoring ongoing research in a silo somewhere, unconcerned that these kinds of cuts, as they don't name "research ethics" explicitly, have nothing to do with them. While reviewing research takes up a tremendous amount of time and energy, as I well know chairing an ethics review board myself, there is a certain amount of advocacy, outreach and education that an ethics review board must be committed to doing, on an ongoing and iterative basis.
This is right on. When my own organization experienced a major financial crisis in late 1999 many painful cuts were made, and I expected that our ethics program might be among them. Instead the COO gave our Ethics Advisory Group a special assignment - recommend a framework of values for dealing with the crisis. He said - wisely - "it's fine to say we endorse five values, but when we have to make tough choices we have to set priorities among them..."

Ethics programs can't solve financial problems by printing money, but they can contribute guidance about how to deal with the crisis in ways most consistent with mission and core values.


Anonymous said...

Nicely said, ethics is many times a way how to find a solution to a problem. They are a vital part in this crisis and should not be looked down at as unimportant. Reviewing current situation and researching the different alternative solutions is a key element of solving this crisis.

Take care, Lorne

Jim Sabin said...

Hi Lorne -

Thanks for this comment.

I agree that ethical reflection often yields new approaches to problems. In teaching medical ethics I often use the "ethics workup" format developed by the late David Thomasma. It involves establishing (a) the pertinent facts, (b) the relevant values, (c) conflicts among the values, (d) priorities among the values and (f) creating options, with the aim of maximizing the outcomes in light of the pertinent values.

The options phase is often VERY creative, as you suggest!

Your address suggests that you are part of the insurance world. I've been urging U.S. health plans to develop ethics program but with very limited success thus far. Are you aware of insurance companies in Canada that have ethics programs?



Anonymous said...

So far there is no real programs in use but this topic has been talked about. After the outbreak of SARS there was a debate on this topic and in November 2007 The Public Health Agency of Canada (PHAC) held the First Canadian Roundtable on Public Health Ethics. I don't think it had any effect though because i haven't heard a thing on this topic since in the public sector.

Take care, Lorne