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Health Care Quality and Ethics in Nursing

The Health Care Quality indicators were developed within the framework of the project launched by the Organization for Economic Co-operation and Development (OECD) to provide the quality assessment tool. These indicators make it possible to compare the quality of health care systems of different countries (Bristow et al., 2013).

One of the major areas covered by the project is cancer care as more than five million cases of the disease are registered annually in the participant countries. Unlike other widespread terminal conditions (such as various heart diseases) cancer mortality does not show any tendency to declination, which means that not enough is done in terms of quality to achieve better results. The following indicators show the quality of cancer care (Bristow et al., 2013):

  • Cancer survival statistics ( including breast, cervical, and colorectal types);
  • Cancer mortality rates (all types taken together and each type separately);
  • Screening rates (including breast and cervical cancers).

A lot of research is currently being done in the given area since the government needs more data for detecting better treatment options. However, the issue is complicated by the presence of the ethical component, which may undermine the conduct of the study and its results in case the research violates ethical principles issued by “The Belmont Report” (Adams & Miles, 2013).

The article that is going to be analyzed in the paper at hand is called “Birth rates among male cancer survivors and mortality rates among their offspring: A population-based study from Sweden”. This study presents interest as it analyzes the ability of male cancer survivors to have children along with the trends in the survival and mortality rates of children whose fathers managed to defeat the disease. The study found out that those men who had a history of cancer treatment were 23% less likely to become fathers in comparison with the rest of the male population of the country. The major factors predetermining the ability to conceive a child included cancer site, its onset during early years of life, parity status at diagnosis, the age of the participant of the experiment, and his recent health condition. The study also concluded that 2.06% of children born to fathers with cancer history died, which means that the mortality rate among such children is approximately the same as among other children. It allows stating that men survivors of cancer are less likely to have children; however, their diagnosis does not seem to have any effect on the mortality of their offspring (Tang et al., 2016).

As far as the study methods are concerned, all the participants were selected from the Swedish Multi-generation Register and Cancer Register, which means that the ethical conduct of the research is rather questionable in this case (Tang et al., 2016). On the one hand, it followed the three fundamental principles outlined in “The Belmont Report” (Adams & Miles, 2013):

  • it showed respect for the people by protecting their right for the autonomy;
  • it did not harm any of the participants and did not put them at any risk associated with the study;
  • the procedure did not benefit any of the participants selectively – they were all treated equally.

Therefore, it seems quite grounded to state that the subjects’ rights were protected and no misconduct of the research took place. However, on the other hand, nothing is stated about the major ethical issue – the informed consent of the research subjects. It is rather doubtful that the researchers could get the consent of several thousand people to be able to use their data for the sake of collecting statistics. It means that technically the rights of the participants were still violated. Nevertheless, it would be fair to note that there is a growing need for collecting data on the subject as more and more people are at risk to get cancer including children of those who have already had the experience of treating the disease. Experiments with a small number of people cannot give the holistic picture of these interdependences. If a huge group of cancer survivors has to be analyzed for assessing the risks that can threaten healthy people, it is impossible to receive the consent of everyone involved. Since the mission is highly important in this case, it justifies the means.

Thus, the study is ethically sound for the following reasons:

  • no patient was forced to participate in the research as no consent was required to collect statistical data about the survivors;
  • the data was not secret and could be used for scientific purposes to improve the quality of health care;
  • the research was careful about considering the side effects of the trial as no one received any physical or moral trauma as a result of it;
  • it fully supported the privacy of all the parties involved and did not uncover any names or other personal data (age, social status, physical condition, etc.)
  • it was performed for the sake of establishing the connection between the previous and the current condition of the survivors (as well as the hazard that it may present to their children), which means that the study can considerably improve the quality of cancer care and clarify some vague areas concerning the disease.

References

Adams, D. P., & Miles, T. P. (2013). The application of Belmont Report principles to policy development. Journal of Gerontological Nursing, 39(12), 16-21.

Bristow, R. E., Powell, M. A., Al-Hammadi, N., Chen, L., Miller, J. P., Roland, P. Y.,… & Cliby, W. A. (2013). Disparities in ovarian cancer care quality and survival according to race and socioeconomic status. Journal of the National Cancer Institute, 105(11), 823-832.

Tang, S. W., Liu, J., Juay, L., Czene, K., Miao, H., Salim, A.,… & Hartman, M. (2016). Birth rates among male cancer survivors and mortality rates among their offspring: A population-based study from Sweden. BMC Cancer, 16(1), 1-12.

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