André Krom

This article reviews educational efforts to promote a responsible conduct of research (RCR) that were reported in scientific publications between 1990 and early 2020. Unlike previous reviews that were exploratory in nature, this review aimed to test eleven hypotheses on effective training strategies. The achievement of different learning outcomes was analyzed independently using moderator analysis and meta-regression, whereby 75 effect sizes from 30 studies were considered. The analysis shows that the achievement of different learning outcomes ought to be investigated separately. The attainment of knowledge strongly benefited from individualized learning, as well as from the discussion and practical application of ethical standards. Contrarily, not covering ethical standards tended to be a feature of successful courses, when looking at other learning outcomes. Overall, experiential learning approaches where learners were emotionally involved in thinking about how to deal with problems were most effective. Primarily intellectual deliberation about ethical problems, often considered the “gold standard” of ethics education, was significantly less effective. Several findings from previous reviews, e.g., the preferability of mono-disciplinary groups, could not be replicated with multivariate analysis. Several avenues for future research efforts are suggested to advance knowledge on the effectiveness of research integrity training.

ABSTRACT Effective infectious disease control may require states to restrict the liberty of individuals. Since preventing harm to others is almost universally accepted as a legitimate (prima facie) reason for restricting the liberty of individuals, it seems plausible to employ a mid‐level harm principle in infectious disease control. Moral practices like infectious disease control support – or even require – a certain level of theory‐modesty. However, employing a mid‐level harm principle in infectious disease control faces at least three problems. First, it is unclear what we gain by attaining convergence on a specific formulation of the harm principle. Likely candidates for convergence, a harm principle aimed at preventing harmful conduct, supplemented by considerations of effectiveness and always choosing the least intrusive means still leave ample room for normative disagreement. Second, while mid‐level principles are sometimes put forward in response to the problem of normative theories attaching different weight to moral principles, employing a mid‐level harm principle completely leaves open how to determine what weight to attach to it in application. Third, there appears to be a trade‐off between attaining convergence and finding a formulation of the harm principle that can justify liberty‐restrictions in all situations of contagion, including interventions that are commonly allowed. These are not reasons to abandon mid‐level theorizing altogether. But there is no reason to be too theory‐modest in applied ethics. Morally justifying e.g. if a liberty‐restriction in infectious disease control is proportional to the aim of harm‐prevention, promptly requires moving beyond the mid‐level harm principle.

A Dutch medical student has the potentially more virulent Panton-Valentine leukocidin form of MRSA colonization yet shows no signs or symptoms of infection. More than a year ago, a routine MRSA screening of health care personnel providing care for MRSA-positive patients detected the colonization. Since then, the student has been treated intensively but unsuccessfully in an attempt to decolonize her. During this decolonization period, the medical student was barred from performing patient-related interventions, temporarily interrupting her medical residency. After initial treatment with mupirocin nasal ointment and antibiotics proved ineffective, a more stringent hygiene regime was added that included hand, nose, hair, and body scrubbing with disinfecting soap. Additional precautions included simultaneous treatment of household members and disinfection of the family home. Despite these efforts, her MRSA status has remained positive. WIP guideline s bar any health care worker diagnosed with MRSA from performing patient-related interventions. Unable to complete the residency requirement of at least 1 year of patient care, the medical student was advised to pursue a career in another profession.

Anticipating the reevaluation of the Dutch organ procurement system, in late 2003 the Rathenau Institute published a study entitled ‘Gift or Contribution?’ In this study, the author, Govert den Hartogh, carries out a thorough moral analysis of the problem of organ shortage and fair allocation of organs. He suggests there should be a change in mentality whereby organ donation is no longer viewed in terms of charity and the volunteer spirit, but rather in terms of duty and reciprocity. The procurement and allocation of donor organs should be seen as a system of mutually assured help. Fair allocation would imply to give priority to those who recognize and comply with their duty: the registered donors. The idea of viewing organ donation as an undertaking involving mutual benefit rather than as a matter of charity, however, is not new. Notwithstanding the fact that reference to charity and altruism is not required in order for the organ donation to be of moral significance, we will argue against the reciprocity-based scenario. Steering organ allocation towards those who are themselves willing to donate organs is both an ineffective and morally questionable means of attempting to counter the organ shortage.

After arrival in a hospital, a man with suspected meningococcal septicaemia slips into a coma. One of his friends posts a message on the patient’s Facebook ‘wall’ informing three named contacts that the patient has meningitis and tells them to speak to a doctor. At the request of the Health Protection Unit (HPU), this message is later modified, to reduce unnecessary anxiety and to provide better guidance (Mandeville et al., 2013). Based on the harm principle and considerations of reasonableness, it will be argued that in this case the HPU is justified to contact the close contacts of the patient individually (via Facebook or otherwise), and to require the enterprising ‘friend’ of the patient to post a modified message on the patient’s Facebook wall advising close contacts to contact the HPU, without naming close contacts. Generally, the internal logic of social networking sites like Facebook (sharing personal information with a broad range of ‘friends’) is contrary to the logic of health care systems (keeping breaches of confidentiality to a minimum). Social networking sites (SNS) could justifiably be used for contract tracing, provided that such use complies with the well-established norms of health care systems