There are many ethical systems and many ways of thinking about good and bad deeds or good and bad character. The field of ethics has traditionally been divided into three areas: (1) metaethics, which deals with the nature of the good or good, as well as the nature and justification of ethical claims; 2.) normative ethics, which deals with the norms and principles used to determine whether something is right or good; 3.) applied ethics, which deals with the actual application of ethical principles to a particular situation. While it is useful to approach the field of ethics in this order, we must bear in mind that this somewhat “top-down” approach does not exhaust the study of ethics. Our experience in applying certain ethical standards or principles may influence our understanding of the quality of those standards or principles. Ideally, a unified global legal and ethical framework could be shared by all countries and regions and allow for transparent sharing of data and samples. Ethical principles already exist for medical research, such as the Declaration of Helsinki, the Taipei Declaration, the Council for International Organizations of Medical Sciences (CIOMS) International Ethical Guidelines for Biomedical Research Involving Human Subjects, and the Organisation for Economic Co-operation and Development (OECD) Guidelines on Human Biobanks and Genetic Research Databases. However, these are not binding instruments under international law. There are also discrepancies between these internationally recognized guidelines. Given the heterogeneity of the regulatory and legal landscape described here, and the disagreement, even in simple terms and definitions, much work is needed to achieve the aforementioned goal of a unified framework. Respect for persons implies two ethical considerations: (1) individuals will and should be treated as autonomous actors, and (2) persons with limited autonomy due to youth, illness, mental retardation or limited freedom (e.g.
prisoners) should be afforded additional protection. The principle of respect for persons means recognizing the authority of an individual`s preferences and decisions about his or her life. In the context of research, the principle of respect for persons is expressed above all in the application of informed consent, which The NPRM proposes an extension of the definition of human subject to deidentified, surplus or remaining biological samples. This extension would require individuals to provide “general” written consent for the use of such biological samples in research – a significant departure from current practice. This would allow patients undergoing tissue excision to grant permission for future unspecified uses of their anonymized biological samples. It is important to understand that biological samples, if properly stored, can last for generations. Such samples have proven useful for treating unexpected medical problems using technologies that did not exist at the time of excision or collection. The failure to consider future research opportunities that could advance knowledge raises questions about the importance and ethical sufficiency of “blanket consent.” For example, if no exemptions were available for the clinical use of biological specimens for which no research use was intended at the time of excision or collection, critical ex-post correlations, such as between Zika virus and microcephaly, may go unnoticed. Guidelines for ethical practices have been in place since the beginning of nursing. An ethical promise for nurses – a modified version of the Hippocratic Oath called the Nightingale Pledge – was developed by Lystra Gretter in 1893. The first code of ethics for nurses was proposed by the American Nurses Association in 1926 and adopted in 1950 (Lyons, 2011). Many ethical situations are unpleasant because we can never have all the information.
Nevertheless, we must act often. The Swedish Ethical Review Act (2003:460), June 5, 2003: www.epn.se/media/2348/the_ethical_review_act.pdf accessed March 14, 2019. In recent decades, the virtuous approach to ethics has been supplemented and sometimes significantly revised by thinkers in the feminist tradition, who often emphasize the importance of the experiences of women and other marginalized groups for ethical considerations. Among the most important contributions of this approach is the fact that the principle of diligence is put forward as a legitimate primary ethical concern, often in contrast to the seemingly cold and impersonal approach to justice. Like virtue ethics, feminist ethics deals with the totality of human life and how that life affects how we make ethical choices. Another difference is that legal norms are written by government leaders, while ethical standards are written according to societal norms. For example, in the United States, standing in line is the social norm.
