Historical i paiiaʻi

Kekahi kūkā o ka noiʻi ethics pono e hooiaio ai, ma loko o ka wā i hala, noiʻi, ua hana weliweli mea ma ka inoa o ka 'epekema. Kekahi o ka mea weliweli o ke Tuskegee Syphilis Study. I ka 1932, noiʻi, mai ka US Public Health Hana (PHS) lākou i heluʻia ma kahi o 400ʻeleʻele kanaka mailoko me syphilis i loko o ke ao, e kanaka hoʻoponopono i ka hopena o ka maʻi. ua pūʻali koa i mea i keia mau kanaka, mai ka wahi a puni Tuskegee, Alabama. Mai ka outset ke ao ua ole-therapeutic; ka mea, ua hoʻololi i wale no kahi i ka moolelo o ka maʻi i loko oʻeleʻele kane. Ka poe i komo ua hoopunipuni mai e pili ana i ke ano o ke ao, ua haiia mai ia ia he ao o ka "ino ke koko" -and ua kaumaha iho la lakou wahahee, a me ineffective lapaʻau, a hiki nae syphilis ka mea, he make maʻi. E like me ke ao holopono, ua? Ac? Palekana pono a me ka ohe. No ka mea, syphilis, aka, na noiʻi Imi intervened e pale aku i na i komo mai ka noho lapaau wahi. No ka mea, laʻana, iloko o ke Kaua Honua II i ka noiʻi hui loaa kikoo deferments no na kanaka a pau i loko o ke ao, i mea e pale aku i ka lapaau i na kanaka ina ua loaa ia lakou i komo i ka puali koa. Noiʻi hoomau i ka hoopunipuni i komo, a hoole aku ia lakou e manaʻo mai iā 40 makahiki. Ka like, he 40-makahiki deathwatch.

Ka Tuskegee Syphilis Study i wahi e ku e kekahi backdrop o ka racism a me ka lōʻihi like ole a pau i pono ma ka hema o ka US i ka manawa. Aka, ma luna o kona 40-makahiki mōʻaukala, ka hoʻopaʻa 'ana i' ole ōlaʻi i noiʻi, o ka poe eleele a me keokeo. A, i hou i ka noiʻi pili 'ole, he nui loa ina ua heluhelu kekahi o ka 15 papa hoike o ke ao pai ia ma loko o ka' inikua moʻokalaleo (Heller 1972) . Ma ka hapalua like-1960s-ma kahi o 30 makahiki ma hope o ke ao, hoomaka ae la-a PHS limahana o Robert Buxtun hoomaka ae la e hookuke iloko o ka PHS e hoʻopau i ke ao, ka mea ana i manao morally outrageous. Ma muli o ia Buxtun, i ka makahiki 1969 o ka PHS i mālama 'ia i panel e hana i ka loa ethical loiloi' ia o ka mahele. Shockingly, ka ethical manual panel hoʻoholo i noiʻi e hoomau oe e aua lapaau mai ka iho mailoko o na kanaka. Iloko o na kūkākūkā 'ana, hoʻokahi lālā o ka panel, a hiki olelo: "Aole loa oe e loaa i kekahi ao e like me keia; e ka lanakila o ia " (Brandt 1978) . Ka a pau keokeo panel, ka mea i ka hapanui ia iluna o na kauka, i hooholo i kekahi ano o ka hoʻomaopopo 'o ia' ae 'ana e lilo. Aka, i ka panel i hooponopono i na kanaka ia lakou iho incapable o ka hoʻolako '' ae, no ko lakou mau makahiki a me ka haahaa nui o ka hoʻonaʻauao 'ana. Ka panel pono, nolaila, i ka noiʻi loaa "surrogate hoʻomaopopo 'o ia' ae" mai kūloko 'inikua ke kula. Pela, a ma hope kekahi, he piha ethical manual, ka aua ana o ka mālama mau. E ho'ōla, Robert Buxtun i ka moʻolelo i ka journalist, a ma ka 1972 Jean Heller kākau i ka moʻo o ka Nupepa 'atikala i paku ole ia i ka hoʻopaʻa' ana i ke ao nei. Ka mea, mahope iho o ka laha lehulehu outrage i ke ao, ua ka hope i pau, a malama i mohai aku ai i ka poe kanaka, ka poe i holo wale no.

Luahi o keia ao like, aole pono i ka 399 kanaka, aka, me ko lākou mauʻohana: ma ka liʻiliʻi 22 wahine, 17 keiki, a 2 moopuna me syphilis e, ua palapala aelike i ka maʻi, e like me ka hopena o ka aua ana o ka lapaʻau (Yoon 1997) . Eia, ka 'ino i ma ka ao mau loa mahope iho o ia mea i pau. Ka like-justifiably-ua hoʻemi i ka hilinaʻi iʻApelika Waena Americans i loko o ka 'inikua kaiāulu, he'aʻaiawā ma ka hilinaʻi i i ua alakaiiaʻApelika Waena-Americans e pale mālama' ana i ka determent o ko lakou ola kino (Alsan and Wanamaker 2016) . Eia, ka nele o ka paulele i keakea pono 'ana e pono HIV / kōkua iā ia, i loko o nā 1980s a me na 90s (Jones 1993, Ch. 14) .

ʻOiai Ka mea, ua paakiki hiki mai i keia la e noonoo ai i na noiʻi i horrific, ke manao nei au, he ekolu nui aʻo mai ka Tuskegee Syphilis Study i nā kānaka e mālama nei nohona noiʻi ma loko o ka mīkini mau makahiki. Mua, he nani a makou i laila, he haʻawina kekahi i wale e ole hiki mai ana. Lua, ua hōʻike mai i ka noiʻi hiki hoeha, aole pono i komo, aka, me ko lākou mauʻohana, a me nā kaiāulu a pau loa mahope iho o ka noiʻi i pau. Eia ke oki, e hōʻike i ka noiʻi hiki i weliweli ethical hoʻoholo. I ka mea, ke manao nei au ia mea e induce kekahi makaʻu i ka noiʻi i keia la, no ka nui o na kanaka komo iloko o keia ao i ka weliweli hoʻoholo ma luna o ia kekahi mau makahiki lōʻihi o ka manawa. A, Eia naʻe, Tuskegee ka mea, ma aole o ia hoʻi, kū hoʻokahi; ka mea, ua mau na examples o problematic lawelawe a me ka 'inikua noiʻi iloko o keia au (Katz, Capron, and Glass 1972; Emanuel et al. 2008) .

I ka 1974, ma ka pane ana i ka Tuskegee Syphilis Study, a me keia mau na ethical 'ana noiʻi, ka US Ahaolelo Lahui i hana i ka National Hoona Kuleana, no ka palekana' ana i He Subjects o Biomedical, a me ke 'ano' Research, a me ia nō ke Komite e nā ethical lula no ka noiʻi 'ole i kanaka kamaaina. Ma hope o eha makahiki o ke anaina ma ka Belmontʻaha kūkā Center, i ka pae hua mai la i ka Belmont Report, he slender aka, ikaika palapala a pau i loaʻa iā ia he weliweli hopena ma na Hōʻuluʻulu Manaʻo ka hakaka ma bioethics, a me ka maʻamau o ka hana pono o noiʻi.

Ka Belmont Report i ekolu pauku. Ma ka mua Pauku-palena ma waena o Hou, a me Research-ka Belmont Report e kuhikuhi aku i kona purview. I like ko, he hoʻopaʻapaʻa no ka mea, i hoʻokaʻawale ma waena o ka noiʻi, ka mea imi generalizable ka ike, a me ka hana, i nā maʻamau o kanaka, a me hanana. Eia, ka mea hoʻopaʻapaʻa i ka ethical loina o ka Belmont Report pili wale no i ka noiʻi. It Ua hoʻopaʻapaʻa i keia hoʻokaʻawale i waena o ka noiʻi, a me ka hana pono hoi kekahi aoao i ka Belmont Report, he misfit i ka lawelawe noiʻi ma loko o ka mīkini makahiki (Metcalf and Crawford 2016; boyd 2016) .

Ka lua a me ke kolu wahi o ka Belmont Hoike waiho mai ekolu ethical kumu-ka mahalo i ka poe; Beneficence; a Lunakanawai, a wehewehe i keia mau kumu e hiki ai e pili ma ka noiʻi hana. O lakou na kumu a pau aʻu i hōʻike 'ia ma hou au mamuli o ka mokuna.

Ka Belmont Report e kuhikuhi ākea pahu hopu, aka, he mea ole ia he palapala e hiki ke hoopuni hoʻohana i poʻe luna no la-i-la hanana. No laila, i ka US Aupuni i hana i ke kaʻina o nā rula i colloquially kapaia ka Lei Rule (ko lakou mau oihana inoa, he Title 45 Code o Federal hooponopono, Mahele 46, Subparts A - D) (Porter and Koski 2008) . Ua mau mea hooponopono e wehewehe i ke kaʻina hana no ka nānā ', e hoike ana, a me ka overseeing noiʻi, a me ka lakou poe i na rula a huiʻoihana Review Boards (IRBs) uaʻano hana me ka pule. E maopopo i ka likeʻole o ka Belmont Report, a me ka poe Lei Rule, noonoo i kela a me keia discusses lohe ae: ka Belmont Report hōʻike ana i ka philosophical kumu no ka 'ae a me ka laula ano a pau eʻoiaʻiʻo' ae ho i oiai ka Lei Rule helu pū koi 'ia kaʻewalu, a me eono pono oihana mua o ka hoʻomaopopo 'o ia ae palapala. Ma ke kanawai, ka Lei Rule noho aupuni aku ai aneane pau noiʻi i loaʻa kālā, mai ka US Aupuni. Eia, he nui kulanui i loaa kālā, mai ka US Aupuni nō kāu pili i ka Lei Ka lula i na mea a pau noiʻi hanaia ana ma ia kula, ka nānā 'ole o ke kālā kumu. Aka, o ka Lei Rule aole nōna pili ma poʻe i ole loaa noiʻi kālā, mai ka US Aupuni.

Ke manao nei au e like me hoikeia ma ka Belmont Report i aneane pau noiʻi mahalo i ka palahalaha pahu hopu o ethical noiʻi, aka, he mea laha mea hoʻonāukiuki me ka Lei Rule, a me ke kaʻina o nā hana, me IRBs (Schrag 2010; Schrag 2011; Hoonaard 2011; Klitzman 2015; King and Sands 2015; Schneider 2015) . E ike, keia noho pilikia o na IRBs aole e ku e ia ethics. E aho, lakou i manaoio i ka 'ōnaehana, aole ia e pepehi i kaupaona kūpono' ole i hiki ke aho loaʻa kona pahu hopu ma kekahi ano. Keia mokuna, nae, e lawe i keia mau IRBs e like me ka haawi mai ai. Ina oe e makemake ia e hahai i na rula o ka IRB, alaila oe e hahai ia lakou. Eia naʻe, ua makemake au e paipai ia oukou e hoi e lawe i kekahi kumu-Aʻo kokoke loa i kahi wa noonoo pono i ka ethics o ko oukou noiʻi.

Keia kāʻei kua loa iki manaʻoi hoʻopōkole 'ko makou hiki i na rula-Aʻo nenoaiu o IRB manual i loko o ka United States. I ka noonoo pono i ka Belmont Report, a me ka Lei Rule i keia la, makou e hoomanao ai lakou i ua hana i loko o kaʻokoʻa ka'āina, a ua-loa sensibly-pane aku ai i na pilikia o ia au, i ka nui o kēia mau naha i ka 'inikua ethics i, a mahope iho o ka Apana World War (Beauchamp 2011) .

A iâ lâkou e ethical hooikaika ma ka 'inikua, a me ke' ano 'epekema e ho okumu ethical nā loina, he poe no hoi uuku a me ka emi loaʻikeʻana i ka polokalamu kamepiulaʻepekema. Eia, ka mua noiʻi e holo iloko o ka ethical ho'āʻo hana ma ka mīkini makahiki noiʻi he ole nohonaʻepekema; lakou he kamepiulaʻepekema, ua hōʻike hewa noiʻi ma ka kamepiula maluhia. I ka 1990s 2000s a me na kamepiula e malu noiʻi 'ana i mālama i ka nui o ka ethically questionable haʻawina i' ole mea like me ka lawe ma luna o botnets, a me hacking iloko o na tausani o na kamepiula 'ē aʻe, me ka nawaliwali kamaʻilio (Bailey, Dittrich, and Kenneally 2013; Dittrich, Carpenter, and Karir 2015) . Ma muli o ia mau haʻawina, ka US Aupuni, ua hōʻike hewa ka 'Oihana o'āina e malu ai-hana, he uliuli-ribbon Komisina e kakau i ana nō ethical? Aieao no ka noiʻi pili i ka' ike a me ka launa pu loea (ICT). Nā hualoaʻa o keia ho'āʻo pono,ʻo ia ka Menlo Report (Dittrich, Kenneally, and others 2011) . ʻOiai Ua like ka pili o ke kamepiula e malu noiʻi, aole ka ia e like me ka lawelawe noiʻi, ka Menlo Report e hoʻolako nui nā haʻawina ekolu no ka lawelawe noiʻi.

Mua, ka Menlo Hoike o ka hōʻoia i ka ekolu Belmont kumu-ka mahalo i ka poe, Beneficence, a me ka Lunakanawai, a ua kō ka ha rula, mahalo no kānāwai, a me na Paio. I i ho'ākāka 'ia i kēia ha rula, a me ka mea e pili ana i ka lawelawe noiʻi i loko o ka papa kuhikuhiE mokuna (Pauku 6.4.4).

Lua, ka Menlo Report kahea e hoʻoneʻe kēlāʻaoʻao kekahi wahi paiki i ka ho'ākāka 'o "noiʻi komo kanaka Beritania" mai ka Belmont Report, i ka oi nui notion o ka noiʻi "noiʻi kanaka-ka hoʻopōʻinoʻia me ka." Na hoʻokau' o ka laulā o ka Belmont Report, ua pono ia manaʻo ma ka Encore. Na IRBs ma Princeton, a me Georgiaʻenehana alii o Encore i ole "noiʻi 'ole i kanaka kamaaina," a nolaila, aole no nae e nānā i lalo o ka na Rule. Eia naʻe, Encore maopopo kanaka-ka hoʻopōʻinoʻia i; ma kona loa loa, Encore hiki potentially ka hopena o na kanaka halaʻole i halepaahao ma repressive aupuni. A me nā loina-Aʻo hoʻokokoke mai aha i noiʻi e ole hūnā i hope he ololi, nā ho'ākāka 'ana o "noiʻi' ole i kanaka kamaaina," a ina IRBs ae aku ia mea. E aho, e apono i ka oi nui notion o "noiʻi me kanaka-ka hoʻopōʻinoʻia." A lakou e hookauwa a pau o ko lakou noiʻi iho i kanaka-ka hoʻopōʻinoʻia i ethical noonoo.

Ke kolu, ka Menlo Report kahea ma noiʻi e hoʻonui i na nā kānaka hoʻopukapuka kālā i ua manaoia i ka wa ana i ka Belmont kumu. E like me ka hana noiʻi, ua neʻe mai ka sphere kaawale o ke ola i ka mea i oi aku i loko iho i ka la-i-la hana, e hoomaka ethical ka noʻonoʻoʻole ma kēlāʻaoʻao o ka pono i ho'ākāka 'noiʻi i komo e komoʻana i komo, a me ka papa kahi a ka noiʻi i kahi. Ma kekahi olelo, ke Menlo Report kahea no ka noiʻi e hoʻolaulā i ko lakou ethical mahinaʻai o Hawaii ma kela aoao o ko lakou mau pono i komo.

I keia moʻolelo i paiiaʻi na 'oi aku ka nui manawa pōkole loiloi' ia o noiʻi ethics i loko o ka nohona a me ka 'inikua' epekema, e like me kamepiula 'epekema. No ka mea, o ka buke loa lapaʻau o ka noiʻi ethics ma ka 'inikua' epekema, ike Emanuel et al. (2008) ai 'ole Beauchamp and Childress (2012) .