1. Research and ethical issues Subject issues—consent and constraints Technology and restraints on technology Does science have all the answers? Is there always a cure or treatment? Are there risks in finding out? Issues of individual and societal expectation

2. Cost, Justice and Control Biomedicine as big business Political control due to cost Is care offered equally (social justice) to everyone or only those who can pay? Controls over research and funding of research

3. Helsinki Accords Principles of research Animal research Dangers of being powerless in the world of research and medicine What constitutes a lack of power

4. Consent Proxy consent for kids Who can consent Therapeutic intent Nuremberg Code

5. Presumed Consent Several states take organs for transplant if there is no express denial of consent for same As opposed to expressed consent to take organs in other states Problem is the lack of organ donors and the large pool of potential recipients

6. Random trials Concept Practice

7. Developing countries research Are they different in terms of consent? Who decides? For what use is their research is the key

8. Cost Effectiveness Cost-effectiveness of the medical therapy is compromised when medical professionals unconsciously extend the application of care beyond that which is prudent” (Roberts, 1980) Who decides? What is the definition of prudent? What is cost-effective with regard to a human life if that life is yours?

9. Outcomes Outcome research is an important part of medical research today Do new drugs and treatments actually improve outcomes? New standard for value of medical treatments Evidence based medicine

10. Outcomes Better with each year Quality of life has not improved No comprehensive plan for outcome research Entitlements may need to be overseen by ethical standards that are not based in equity

11. Low Technology Research Simple straight-forward actions by individuals to decrease risk and improve long term health No evidence that this is taught or emphasized in any medical school Self-help is key Knowledge is key

12. Embryos and Sperm Banks Only 16% of embryos and 10% of sperm banked in the US are ever used Should the individual donor have the ultimate say in how they are used? Should moral arguments control the debate on use? Should science and discovery control?

13. Example Should drug companies run their own drug trials to determine the efficacy of a new drug? Are these drug company run studies by definition tainted and unreliable?

14. Summary Technology is pressing the limits of ethics and social epistemologies Organized efforts to control decision-making based on clear and accepted socially determined guidelines Do no harm Social justice and equality Cost