Ethical Considerations, Research Paper Example

PICO Question

In patients suffering from psoriatic arthritis, are biological pharmacological treatments more effective than non-biological pharmacological treatments in reducing pain and improving quality of life?

P– Patients with psoriatic arthritis.

I- Biological pharmacological treatments.

C– Non-biological pharmacological treatments.

O- Pain reduction and improved quality of life.

Article One Summary

Michelsen et al. (2017) investigated 728 patients to see the relationship between baseline depression and anxiety regarding remission of joint pain in patients being treated with disease-modifying rheumatic drugs. Baseline depression and anxiety were found to be strong negative predictors of remission (Michelsen et al., 2017). Overall, both anxiety and depression are disorders that are very common in the general population and should be monitored as part of routine care for patients who have psoriatic arthritis (Michelsen et al., 2017).

Ethical Considerations for Article One

Michelsen et al. (2017) completed the ethical consideration of informed consent. “Written informed consent was obtained from each patient” (Michelsen et al., 2017). It should be said that informed consent is compulsory for research and clinical trials with human subjects. Michelsen et al. (2017) provided facts and information about all details of the research study, including but not limited to the purpose of the study and the potential for harm and benefits, to each participant to obtain informed consent. The participants were free to use the provided information to decide on whether to participate in research studies. Importantly, obtaining informed consent also entailed voluntary participation in the research study and ensuring the confidentiality of the research participants. Therefore, Michelsen et al. (2017) completed the following ethical considerations as part of their observational study: voluntary participation, explaining the potential for harm and benefits, and protecting participants’ confidentiality.

Ethical Principles for Article One

It should be pointed out that Michelsen et al. (2017) followed the principle of autonomy since the researchers obtained informed consent and the participants of their research took part in the research voluntarily. It is interesting to note that informed consent embraces the idea of personal autonomy, which refers to a patient’s potential to separate and take in preference, and autonomous choice, which refers to the free will of the patient’s choice. Furthermore, the principle of autonomy suggests that individuals responsible for carrying out clinical research must ensure that human subjects involved in that research understand that they have the privilege to choose whether to take part in research studies voluntarily.

Also, Michelsen et al. (2017) followed the principle of beneficence because the researchers explained the potential for harm and benefits to the participants. Michelsen et al. (2017) fulfilled the requirement that that the potential harm, physical harm, for example, and benefits, availability of a likely valuable intervention, for example, should be described in detail to research participants. Doing so made it possible for the researchers to reduce harm and promote patient well-being to match the principle of beneficence.

Finally, Michelsen et al. (2017) followed the principle of justice because the researchers protected participants’ confidentiality. Michelsen et al. (2017) were responsible for keeping information about participants confidential, thus, upholding the right to privacy. Significantly, because the right to privacy is part and parcel of the principle of justice,” protecting participants’ confidentiality is attributed to the principle of justice.

Article Two Summary

Psoriasis is one of the most chronic inflammatory skin diseases (Scher et al., 2019). The disease starts off with cutaneous involvement and later progresses to synovial inflammation, which leads to the development of arthritis (Scher et al., 2019). While the exact molecular mechanism of this condition remains unclear, therapy targeting the IL-23-IL-17 axis has led to improved outcomes in patients with psoriatic arthritis (Scher et al., 2019).

Ethical Considerations for Article Two

Scher et al. (2019) conducted a systematic review, which did not require ethics committee approval. Besides, unlike randomized controlled trials, for example, the authors of which collect, keep, and analyze non-public confidential information of participants, the nature of systematic reviews made it possible for Scher et al. (2019) to skip this step. Consequently, one could state that there was no need for Scher et al. (2019) to complete ethical considerations as part of their systematic review, except the ethical considerations of voice and representation and stakeholder interests.

Principles for Article Two

Because neither of the ethical considerations was mentioned in the above section, the ethical principles cannot be identified for the systematic review conducted by Scher et al. (2019).

Article Three Summary

Patients presenting with symptoms of depression and anxiety at tumor necrosis factor inhibitor (TNFi) initiation are associated with significantly decreased treatment outcomes (Zhao et al., 2021). Treatment outcomes may be preserved and increased when anxiety and depression are also addressed and treated. Zhao et al. (2021) investigated 742 participants with symptoms ranging from mild to severe symptoms of anxiety and depression participants with moderate to severe depression had a much poorer response to therapy when compared to those who did not fall in that category.

Ethical Considerations for Article Three

Ethical considerations for the observational research carried out by Zhao et al. (2021) overlap with ethical considerations for the observational research carried out by Michelsen et al. (2017). “Written informed consent was obtained from all participants” (Zhao et al., 2021). As mentioned above, obtaining written informed consent entails voluntary participation, explaining the potential for harms and benefits, and protecting participants’ confidentiality. Consequently, those ethical considerations have been completed as part of the observational research.

Ethical Principles for Article Three

The identified ethical considerations for article three are attributed to the principle of autonomy, the principle of beneficence, and the principle of justice.

Discussion

The 1978 Belmont Report, which promoted the unifying ethical principles, was the first step towards protecting the rights of participants in clinical trials involving human subjects (Barrow, Brannan, & Khandhar, 2020). These days any research involving human subjects is thoroughly scrutinized for abiding by the four ethical principles, namely, beneficence, nonmaleficence, autonomy, and justice. Michelsen et al. (2017) and Zhao et al. (2021) also applied the principles of beneficence, autonomy, and justice to their observational researches.

It should be said one could see a link between obtaining written informed, voluntary participation, explaining the potential for harms and benefits, protecting participants’ confidentiality and the principles of autonomy, beneficence, and justice. At the same time, as a general rule, ethical considerations are not completed as part of systematic reviews due to the nature of secondary research.

References

Barrow; J. M., Brannan, G. D., & Khandhar, P. B. (2021). Research ethics. Treasure Island:

StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459281/

Forister, J. G., & Blessing, J. D. (2020). Introduction to research and medical literature for health professionals. (5th ed.). Jones & Bartlett Learning.

Michelsen, B., Kristianslund, E. K., Sexton, J., Hammer, H. B., Fagerli, K. M., Lie, E., … & Kvien, T. K. (2017). Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study. Annals of the Rheumatic Diseases, 76(11), 1906-1910. https://doi.org/10.1136/annrheumdis-2017-211284

Scher, J.U., Ogdie, A., Merola, J.F (2019). Preventing psoriatic arthritis: Focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol 15, 153–166. https://doi.org/10.1038/s41584-019-01×75-0

Zhao, S. S., Jones, G. T., Hughes, D. M., Moots, R. J., & Goodson, N. J. (2021). Depression and anxiety symptoms at TNF inhibitor initiation are associated with impaired treatment response in axial spondylarthritis. Rheumatology. https://doi.org/10.1093/rheumatology/keab242