Florence Nightingale and Responsibility for Healthcare in the Home

The focus for this article is the approach taken by the famous British nurse and public health reformer Florence Nightingale (1820–1910) to responsibility for care, with particular reference to healthcare as practised in the home. It begins by examining Nightingale’s involvement as a young woman in ‘Lady Bountiful’ style upper-class charitable health visiting in the period before 1850. It goes on to consider the district nursing model designed by Nightingale and William Rathbone in the 1860s as an attempt to adapt this localised model of charitable care to the demands of industrial Victorian cities. The final section broadens the lens to examine Nightingale’s views on religious vocations in care work and the state’s expanding role in regulating the nursing profession. Nightingale’s ideal vision of care combined multiple elements: attachment to a local community, a sense of religious vocation, and the scalability and fundraising of national or governmental organizations.

Dealing with Ethical Issues in Clinical Trials: The ussr in the Global Context

This paper discusses several ethical issues related to clinical trials within the Soviet system of drug development and testing, which reflected larger ideological principles of healthcare organization in the ussr, with its focus on eradicating market elements from drug development. The centralized state-controlled system was thought to combat such drawbacks of free-market drug development as high prices and aggressive advertising; also to discourage the duplication of research by numerous independent actors that was perceived to be common in capitalist countries. Another significant ethical issue was the Soviet emphasis on the unity of scientific research and clinical treatment. Their strict separation, introduced to support normative standards defined by the U.S. pharmaceutical drug testing system, was rejected in the ussr where knowledge of new treatment options came from treatment practice, not laboratory-like experimental conditions of randomized controlled double-blind trials. The Soviet design was closer to so-called ‘pragmatic trials’ that focus on solving ‘real-life’ problems in clinical practice. Not all ethical problems were successfully addressed in the Soviet model, where there were always significant gaps between neatly postulated theory and messy clinical practice. The unity of scientific research and clinical practice was difficult to achieve. Archival research shows potential ethical issues related to geographic disparities in carrying out clinical trials, and the importance of personal and informal connections in the Soviet model.

“An Official Conscience and Warranting Agency”: Institutional Isomorphism and the Rise of Dutch Ethics Review in the 1970s and 1980s

Why did medical research involving human subjects, a practice that is arguably as old as medicine itself, come to be regulated by research ethics committees in the late twentieth century? In this essay, I answer this question for the Netherlands, by querying the rise of ethics review in the 1970s and 1980s through the lens of “institutional isomorphism”. Drawing on the classic work of Paul Dimaggio and Walter Powell, I argue that extra-national changes to funding and publishing requirements in this period were identifiably more important for the emergence of ethics review in the Netherlands than were ethical concerns for research misconduct – a process that was marked by definitive elements of internationally coercive, and perhaps also of mimetic isomorphism. In addition, I detail how, as a consequence of these developments, those involved in Dutch ethics review came to consider “variation and inconsistency” as one of the system’s biggest problems in the late 1980s. To remedy this, numerous normative isomorphic attempts were undertaken in the late twentieth century to make all Dutch research ethics committees act in the same way. This emphasis on institutional homogeneity has been borne out in the Netherlands, even though it has repeatedly been criticized for hampering democratic and ethical decision-making.

The Missing Committees: Research Ethics in the Making in Switzerland

This article analyzes the formation of research ethics and particularly of ethics committees in Switzerland by tracing their early history along distinct phases: (1) the first guidelines on human experimentation issued by the Swiss Academy of Medical Sciences in 1970; (2) conceptual struggles in establishing these norms; (3) the emergence of a central medical-ethical committee in 1979; and (4) the first local ethics committee established in the rural canton of Thurgau in 1987. It analyzes the interplay between local practices, industrial standards, and a neoliberal, low-key, soft regulation by negotiation among peers. Key actors are the Swiss Academy of Medical Sciences, the pharmaceutical industry, and the canton of Thurgau. In this context, ‘research’ and ‘experiments’ for a long time remained disputed, unclear and risky notions. rec s were encouraged mainly as a way of distributing responsibility, of managing a wide array of risks and, crucially, as part of a wider strategy to avoid juridical and political regulation. The article asks, on a more general level, how and why ‘ethics’ entered this field and what becomes visible or obscured when issues are transposed into an ethical language.

Regulating Research: The Origins and Institutionalization of Research Ethics Committees in Sweden

The year 1966 saw the birth of Sweden’s first formal Research Ethics Committee (rec) at the medical university Karolinska Institute (ki). In the following years other ethical committees were institutionalized, coordinated by a working group steered by the Swedish Medical Research Council (smrc). Research ethical issues of a principled nature were also discussed by the Ethics Delegation of the Swedish Society of Medicine (ssm). Between 1966 and 1975, around 500 research proposals were assessed by rec s in Sweden, and the medical community started to follow certain protocols when preparing applications for ethical review. This paper traces the origins and early development of the rec system in Sweden and offers an analysis of their practices, discussions, and assessments through the reading of meeting protocols and correspondence between central actors. The aim is to sketch out how and why the system of research ethics committees emerged, became institutionalized, and developed in Sweden from the 1960s to the early 1980s. This paper connects to the recent empirical turn in historical research on medical research ethics and regulations, by focusing on how the insiders, i.e., the medical community, reacted to new demands of ethical review. The analysis illustrates how the medical researchers interacted with transnational funders, the Patients Association, a broader public, governmental authorities, and parliamentary politics when developing the Swedish rec system.