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  • ETH8: Does the implementation or withdrawal of IGG challenge or change professional values, ethics or traditional roles?
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Does the implementation or withdrawal of IGG challenge or change professional values, ethics or traditional roles?

Authors: Plamen Dimitrov, Anelia Koteva

Internal reviewers: Pseudo99 Pseudo99

Traditionally accepted is the notion that in order to be good professionals, healthcare workers besides good qualifications must possess a number of moral virtues and personal qualities, such as compassion, insight, trustworthiness, honesty, integrity and conscientiousness, with the care for patients being based on responsibility, loyalty and mutual trust.


Development of medical science with the invention of new diagnostic and therapeutic procedures poses a number of challenges facing the healthcare workers that could consciously or unconsciously affect their attitude towards patients. The doctors’ wish to find a new effective and successful therapy for treating Alzheimer’s disease prior to the onset of irreversible damages in the brain of patients may cause in healthcare professionals ungrounded optimism, thus obscuring their humane intentions by permitting the enrollment of decisionally impaired persons or subjects deprived of sufficient information in the group for experimental clinical trials. Medical personnel should cautiously balance positive against negative outcomes from the experimental therapy and provide the individuals with accessible, comprehensive factual information on the features, benefits and harms of the new treatment, including the usage of non-verbal methods when needed.


Clinicians should also consider the fact that they are placed in a position intimidating patients in several ways: 1.) Patients do not have enough knowledge to decide for themselves what is good for their own prevention and therefore completely trust the honesty, benevolence and professional advice of physicians/researchers (particularly with regard to incapacitated persons, who, while seeking the best solution for their own health problem, entrust their health and lives in the hands of professionals with the conviction that the latter will act in their best interest.); 2.) Medical staff by virtue of its competence and social status may be intimidating to patients by silently forcing them to agree with everything, thereby depriving them of exercising their right to personal autonomy, even in cases when what is required by the patient may not be in his/her best interest (i.e. an abuse of official position – something that should not be allowed.); 3.) Researchers are obligated to ensure full confidentiality of the data acquired during the experiment since in the course of the study there is a risk of becoming aware of sensitive patient information, whose disclosure would endanger the patient’s social and economic interests.; 4.) The staff must guarantee the principle of voluntariness upon signing the informed consent, bearing in mind that with a view to the patients’ progressive mental deterioration, informed consent should be considered an ongoing process with an option to be potentially revised over time. Coercion, manipulation, fraud and other unethical methods are totally unacceptable or undesirable, with researchers being obliged to envisage measures for protection of the personal data of their patients.; 5.) In an effort to cure or slow disease progression, healthcare professionals might be influenced by the pharmaceutical companies advertising new drugs, without at the same time being sufficiently convinced of the effectiveness of the proposed treatments. Reasonable in this context would be questions such as: How will patients’ quality of life change?; If and how effective are these  drugs?; Do they induce the same side effects?; Is the cost, duration and treatment dose, etc. justified?;  If, moreover, in an experiment involving the testing of new therapeutic methods, medical staff accepts funding from the pharmaceutical industry, a conflict of interest may arise, questioning both the objectivity of the experiment and the expected results.

Dimitrov P, Koteva A Result Card ETH8 In: Dimitrov P, Koteva A Ethical analysis In: Jefferson T, Cerbo M, Vicari N [eds.]. Use of Intravenous immunoglobulins for Alzeheimer’s disease including Mild Cognitive Impairment [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 31 October 2020]. Available from: