Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-20T01:34:38.293Z Has data issue: false hasContentIssue false
  • English
  • Français

Research Ethics and Justice: The Case of Finland

Published online by Cambridge University Press:  12 July 2019

TUIJA TAKALA  and
MATTI HÄYRY
Get access Rights & Permissions [Opens in a new window]

Abstract:

This paper explores how Finnish research ethics deals with matters of justice on the levels of practical regulation, political morality, and theoretical studies. The bioethical sets of principles introduced by Tom Beauchamp and James Childress in the United States and Jacob Dahl Rendtorff and Peter Kemp in Europe provide the conceptual background, together with a recently introduced conceptual map of theories of justice and their dimensions. The most striking finding is that the internationally recognized requirement of informed consent for research on humans can be ideologically tricky in a Scandinavian welfare state setting.

Keywords

justicebioethicsresearch ethicsFinlandautonomynonmaleficencebeneficenceprecautionsubsidiaritysolidarityresponsibilitydignityintegrityvulnerabilityconsentwelfare state
Type
Departments and Columns
Information
Cambridge Quarterly of Healthcare Ethics , Volume 28 , Issue 3 , July 2019 , pp. 551 - 576
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

This section aims to go beyond day-to-day issues in research ethics by considering their background theories and assumptions. The starting point of contributions can be in real-life questions and answers to them, but the main objective is to explore their historical and theoretical bases. For ideas and submissions, contact Tuija Takala at [email protected]

Acknowledgements: The authors thank the Academy of Finland (projects SA 272467 and SA 307467) and the Finnish Cultural Foundation (project Justice and Its Alternatives in a Globalizing World) for their financial support.

References

Notes

1. The Nuremberg Code (1947); available at history.nih.gov/research/downloads/nuremberg.pdf (last accessed 23 Oct 2017).

2. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects (2013, orig. 1964); available at jamanetwork.com/journals/jama/fullarticle/1760318 (last accessed 23 October 2017).

3. The Belmont Report (1979); available at www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html (last accessed 23 Oct 2017).

4. Bayles M. Mid-level principles and justification. In: Pennock JR, Chapman JW, eds. Justification. New York, NY: New York University Press; 1986:49–67.

5. Beauchamp, T, Childress, J. Principles of Biomedical Ethics. New York, NY: Oxford University Press; 1979. (Now in its seventh edition, 2012.)Google Scholar

6. Cf, Häyry M. Ethics committees, principles and consequences. Journal of Medical Ethics 1998;24:81–5.Google Scholar

7. Häyry, M. Doctrines and dimensions of justice: Their historical backgrounds and ideological underpinnings. Cambridge Quarterly of Healthcare Ethics 2018;27:188–216.CrossRefGoogle ScholarPubMed

8. Jonas H. Das Prinzip Verantwortung: Versus einer Ethik für die technologische Zivilisation, seventh edition. Frankfurt am Main: Insel; 1987; Häyry, M, Takala, T. Genetic engineering and the risk of harm. Medicine, Health Care and Philosophy 1998;1:61–4;CrossRefGoogle ScholarPubMed Häyry, M. Precaution and solidarity. Cambridge Quarterly of Healthcare Ethics 2005;14:199–206;CrossRefGoogle ScholarPubMed Holm, S, Takala, T. High hopes and automatic escalators: A critique of some new arguments in bioethics. Journal of Medical Ethics 2007;33:1–4;CrossRefGoogle ScholarPubMed Häyry, M. Rationality and the Genetic Challenge: Making People Better? Cambridge: Cambridge University Press; 2010.CrossRefGoogle Scholar

9. Häyry, M, Takala, T. American principles, European values, and the mezzanine rules of ethical genetic data banking. Häyry, M, Chadwick, R, Árnason, V, Árnason, G, eds. The Ethics and Governance of Human Genetic Databases: European Perspectives. Cambridge: Cambridge University Press; 2007,14–36.CrossRefGoogle Scholar

10. Bayertz K, ed. Solidarity and the Welfare State. Ethical Theory and Moral Practice 1 (1998):293–392. Houtepen R, ter Meulen R, eds. Solidarity in Health Care. Health Care Analysis 8 (2000):329–411. Cf. Takala T. Justice for all? —The Scandinavian approach. In: Rhodes R, Battin M, Silvers A, eds. Medicine and Social Justice: Essays on the Distribution of Health Care. New York, NY: Oxford University Press; 2002:183–90; Takala, T, Häyry, M. Is communitarian thinking altruistic? Trames 2004;8:276–83;Google Scholar Takala, T. Gender, disability and personal identity. In: Kristiansen, K, Shakespeare, T, Vehmas, S, eds. Arguing about Disability: Developing a Philosophical Framework. London: Routledge; 2009a:124–33;Google Scholar Takala T. Human before sex? Ectogenesis as a way to equality. In: Simonstein F, ed. Reprogen Ethics and the Future of Gender. New York, NY: Springer; 2009b:187–95; Ahola-Launonen J. The evolving idea of social responsibility in bioethics: A welcome trend. Cambridge Quarterly of Healthcare Ethics 2015;24:204–13; Ahola-Launonen J. Social responsibility and healthcare in Finland. Cambridge Quarterly of Healthcare Ethics 2016;25:448–65.

11. Rendtorff JD, Kemp P, eds. Basic Ethical Principles in European Bioethics and Biolaw Volumes 1 & 2. Copenhagen and Barcelona: Centre for Ethics and Law & Institut Borja de Bioètica; 2000; Häyry M. European values in bioethics: Why, what, and how to be used? Theoretical Medicine and Bioethics 2003;24:199–214; Häyry M. Another look at dignity. Cambridge Quarterly of Healthcare Ethics 2004;13:7–14; Häyry M. The tension between self-governance and absolute inner worth in Kant’s moral philosophy. Journal of Medical Ethics 2005;31:645–7; Häyry M, Takala T. Human dignity, bioethics, and human rights. Developing World Bioethics 2005;5:225–33; Takala T. Concepts of “person” and “liberty”, and their implications to our fading notions of autonomy. Journal of Medical Ethics 2007;33:225–8; Häyry M. Some current issues in the ethics of biomedical research and their background in the protection of the dignity and autonomy of the vulnerable. In: Häyry M, Takala T, Herissone-Kelly P, eds. Ethics in Biomedical Research: International Perspectives. Amsterdam and New York, NY: Rodopi; 2007:21–32.

12. Löppönen P, Vuorio E. Tutkimusetiikka Suomessa 1980-luvulta tähän päivään [Research ethics in Finland from the 1980s to this day]. Tieteessä tapahtuu 1/2013:3–10.

13. Syväterä J. Creation and Domestication of Global Policy Trends: The case of national bioethics committees. Tampere: Acta Universitatis Tamperensis 2159; 2016.

14. Halila R. The role of national ethics commissions in Finland. Bioethics 2003;17:357–68.

15. The tasks of the Finnish National Board on Research Integrity. Available at www.tenk.fi/en/tasks (last accessed 23 Oct 2017).

16. Investigation of misconduct in Finland. Available at www.tenk.fi/en/investigation-of-misconduct-in-finland (last accessed 23 Oct 2017).

17. Advisory Board on Biotechnology. Available at www.btnk.fi/en/index.html (last accessed 23 Oct 2017).

18. See note 14, Halila 2003, at 358.

19. Board for Gene Technology. Available at geenitekniikanlautakunta.fi/en/frontpage (last accessed 23 Oct 2017).

20. See note 14, Halila 2003, at 359.

21. The National Advisory Board on Social Welfare and Health Care Ethics. Available at etene.fi/en/frontpage (last accessed 23 Oct2017).

22. See note 14, Halila 2003, at 359.

23. Operations of the National Committee on Medical Research Ethics. Available at tukija.fi/en/operations (last accessed 23 Oct 2017).

24. National Committee on Medical Research Ethics. Available at tukija.fi/en/frontpage (last accessed 23 Oct 2017). See also note 14, Halila 2003 at 360.

25. Duties of the National Committee on Medical Research Ethics. Available at tukija.fi/en/duties (last accessed 23 Oct 2017).

26. The Animal Experiment Board. Available at www.laaninhallitus.fi/lh%5Cetela%5Chankkeet%5Cellapro%5Chome.nsf/pages/indexeng (last accessed 25 July 2017).

27. Directive 2010/63/EU. Available at https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2010:276:0033:0079:EN:PDF (Last accessed 16 Mar 2019).

28. Co-Operaration Group for Laboratory Animal Sciences. Available at www.kytö.fi/lh/etela/hankkeet/kyto/home.nsf/pages/219854187D88CBE8C22577A0003C1CF9?opendocument (last accessed 23 Oct 2017).

29. Council on the Protection of Animals Used for Scientific and Educational Purposes. Available at mmm.fi/en/laboratory-animals (last accessed 23 Oct 2017).

30. Russell WMS, Burch RL. The Principles of Humane Experimental Technique. London: Methuen; 1959.

31. The Finnish Medicine Agency. Available at www.fimea.fi/web/en/about_us (last accessed 23 Oct2017).

32. The Animal Experiment Board. Available at www.laaninhallitus.fi/lh%5Cetela%5Chankkeet%5Cellapro%5Chome.nsf/pages/indexeng (last accessed 23 Oct 2017).

33. Contained use of genetically modified micro-organisms. Available at geenitekniikanlautakunta.fi/en/contained-use/microorganisms (last accessed 23 Oct 2017).

34. Contained use of genetically modified plants. Available at geenitekniikanlautakunta.fi/en/contained-use/plants (last accessed 23 Oct 2017).

35. Contained use of genetically modified animals. Available at geenitekniikanlautakunta.fi/en/contained-use/animals (last accessed 23 Oct 2017).

36. Deliberate release of genetically modified organisms. Available at geenitekniikanlautakunta.fi/en/deliberate-release (last accessed 23 Oct 2017).

37. Medical Research Act 488/1999. Available at www.finlex.fi/en/laki/kaannokset/1999/en19990488.pdf (last accessed 23 Oct 2017).

38. Human stem cells, cloning and research. Available at www.btnk.fi/files/pdf/kantasolu.pdf (last accessed 23 Oct 2017).

39. Ethical principles of research in the humanities and social and behavioural sciences and proposal for ethical review, 2009. Available at www.tenk.fi/sites/tenk.fi/files/ethicalprinciples.pdf (last accessed 23 Oct 2017).

40. National Institute for Health and Welfare. Available at www.thl.fi/en/web/thlfi-en (last accessed 23 Oct 2017).

41. Ethical review and administrative governance of clinical research. Available at www.thl.fi/en/web/thlfi-en/research-and-expertwork/projects-and-programmes/ethical-review-and-administrative-governance-of-clinical-research-mergo- (last accessed 23 Oct 2017).

42. The Finnish Institute of Bioethics. Available at www.bioethics.fi/ (last accessed 23 Oct 2017).

43. Our thanks are due to Susanne Uusitalo (University of Helsinki), Helena Siipi (University of Turku), and Markku Oksanen (University of Eastern Finland) for providing us with their insights.

44. The only academic “bioethics” title in Finland is “Docent of Bioethics” (mainly honorary), held at the University of Tampere by Matti Häyry since 1992.

45. Launis V, Portin P. Bioetiikan ala Turussa laaja-alainen [The scope of bioethics in Turku is wide]. Tieteessä tapahtuu 2/2014:54–5. Other active researchers in Turku include Juha Räikkä, Marko Ahteensuu, and Mari Kangasniemi.

46. About half of the publications on “bioethics” listed in the University of Helsinki research database are by three academics who left the institution around 2001 (Sirkku Hellsten, Matti Häyry, and Tuija Takala) and their students (e.g., Johanna Ahola-Launonen). On the early parts of this development, see Häyry M. My way to bioethics—A story of otherness and chance encounters. Louhiala P, Stenman S, eds. Philosophy Meets Medicine. Acta Gyllenbergiana 1. Helsinki: Helsinki University Press, 2000, 149–61.

47. Markku Oksanen and Elisa Aaltola.

48. Mika Hämäläinen.

49. Susanne Uusitalo.

50. UNESCO Chair in Bioethics Finnish Unit. Available at blogit.utu.fi/unescochairinbioethics/ (last accessed 23 Oct 2017).

51. Häyry M. Liberal Utilitarianism and Applied Ethics. London: Routledge; 1994, at 55–67; Häyry M. Public health and human values. Journal of Medical Ethics 2006;32:519–21.

52. Takala, T, Häyry, M. Genetic ignorance, moral obligations and social duties. Journal of Medicine and Philosophy 2000;25:107–13;CrossRefGoogle ScholarPubMed Häyry, M, Takala, T. Genetic information, rights, and autonomy. Theoretical Medicine and Bioethics 2001;22:403–14;CrossRefGoogle ScholarPubMed Häyry, M. Forget autonomy and give me freedom! Häyry, M, Takala, T, Herissone-Kelly, P, eds. Bioethics and Social Reality. Amsterdam and New York: Rodopi, 2005; 31–7;Google Scholar Häyry, M, Takala, T. Coercion. Ten Have H, ed. Encyclopedia of Global Bioethics. Cham: Springer; 2016. Online.Google Scholar

53. See note 11, Häyry 2004.

54. See note 8, Häyry 2005; see note 10, Ahola-Launonen 2015.

55. See note 7, Häyry 2018.

56. Beauchamp TL. The “four principles” approach to health care ethics. Ashcroft RE, Dawson A, Draper H, McMillan JR, eds. Principles of Health Care Ethics, 2nd ed. Chichester: John Wiley & Sons; 2007: 3–10, at 3.

57. See note 56, Beauchamp 2007, at 6.

58. See note 11, Rendtorff and Kemp, 2000 Vol. 1.

59. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 18.

60. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 18.

61. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 19.

62. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 19.

63. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 22–3.

64. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 23–4.

65. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 25–31.

66. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 31–5.

67. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 40.

68. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 48.

69. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 48–56.

70. See note 11, Rendtorff and Kemp 2000 Vol. 1, at 56–61.

71. See note 7, Häyry 2018.

72. See note 56, Beauchamp 2007, at 6.

73. E.g., Nozick R. Anarchy, State, and Utopia. Oxford: Blackwell; 1974.

74. E.g., Cohen G. Self-Ownership, Freedom, and Equality. Cambridge: Cambridge University Press; 1995; Cohen G. If You’re an Egalitarian, How Come You’re So Rich? Cambridge, MA: Harvard University Press; 2001.

75. Rawls J. A Theory of Justice. Cambridge, MA: The Belknap Press of Harvard University Press; 1971; Rawls J. Political Liberalism [orig. 1993], extended edition. New York, NY: Columbia University Press; 2005; Rawls J. The Law of Peoples. Cambridge, MA: The Belknap Press of Harvard University Press; 2001.

76. Bentham J. An Introduction to the Principles of Morals and Legislation [1789]. Burns JH, Hart HLA, eds. London and New York: Methuen; 1982; Bentham J. The Theory of Legislation. Ogden CK, ed. London: Kegan Paul & Co.; 1931); Mill JS. On Liberty [1859]; available at oll.libertyfund.org/titles/mill-on-liberty-and-the-subjection-of-women-1879-ed (last accessed 23 Oct 2017); Mill JS. Utilitarianism [1863]; available at oll.libertyfund.org/titles/mill-boll-48-j-s-mill-utilitarianism-1863?q=mill+utilitarianism (last accessed 23 Oct 2017); Harsanyi J. Morality and the theory of rational behaviour. In: Sen A, Williams B, eds. Utilitarianism and Beyond. Cambridge: Cambridge University Press; 1982: 39–62. See also note 51, Häyry 1994.

77. Eg., Thomas Pogge’s commentary, February 12, 2011; available at http://www.askphilosophers.org/question/3830 (last accessed 23 Oct 2017).

78. Eg., Sandel M. Liberalism and the Limits of Justice. Cambridge: Cambridge University Press; 1982; Sandel M. Justice: What Is the Right Thing to Do? London: Penguin Books; 2009.

79. Eg., Wenar L. John Rawls. In: Zalta EN, ed. The Stanford Encyclopedia of Philosophy (Spring 2017 Edition); available at https://plato.stanford.edu/archives/spr2017/entries/rawls/ (last accessed 23 Oct 2017).

80. Eg., Sen A. The Idea of Justice. Cambridge, MA: The Belknap Press of Harvard University Press; 2011, at 192.

81. Nussbaum MC. Sex and Social Justice. Oxford: Oxford University Press; 1998; Nussbaum MC. Frontiers of Justice: Disability, Nationality, Species Membership. Cambridge, MA: The Belknap Press of Harvard University Press; 2006.

82. Eg., Gilligan C. In a Different Voice: Psychological Theory and Women’s Development. Cambridge, MA: Harvard University Press; 1982; Feder Kittay E. Love’s Labor: Essays on Women, Equality, and Dependency. London: Routledge, 1999.

83. See note 81, Nussbaum 2006. Amartya Sen opposed the idea.

84. John Finnis presents a list that is almost identical with Martha Nussbaum’s list, yet they disagree, based on their ideological assumptions, strongly on many important issues. Finnis J. Natural Law and Natural Rights (second edition). Oxford University Press; Oxford 2011. See note 81, Nussbaum 2006.

85. Cf., however, Nussbaum MC. Political liberalism and global justice. Journal of Global Ethics 2015;11:68–79.

86. See note 8, Häyry 2005.

87. Capital letters in European Human Rights Thinking added to make a distinction to appeals to universal human rights considerations in other, less parochial, senses.

88. See note 84, Finnis 2011.

89. See note 38, www.btnk.fi/files/pdf/kantasolu.pdf (last accessed 23 Oct 2017).

90. See note 39, www.tenk.fi/sites/tenk.fi/files/ethicalprinciples.pdf (last accessed 23 Oct 2017).

91. Ministry of Social Affairs and Health, Finland. Biobank Act (688/2012); available at http://www.finlex.fi/en/laki/kaannokset/2012/en20120688.pdf (last accessed 23 Oct 2017).

92. This, of course, is a wider problem. See, e.g., Hayden CH. A broken contract. Nature 2012;484:312–4; available at http://www.nature.com/polopoly_fs/1.10862!/menu/main/topColumns/topLeftColumn/pdf/486312a.pdf (last accessed 23 Oct 2017).

93. Centers for Disease Control and Prevention. U.S. Public Health Service Syphilis Study at Tuskegee; available at https://www.cdc.gov/tuskegee/timeline.htm (last accessed 23 Oct 2017).

94. See, e.g., Teivainen A. Daily: Finland’s liability act does not recognize human rights violations. Helsinki Times 28 August 2013; available at http://www.helsinkitimes.fi/finland/finland-news/domestic/7456-daily-finland-s-liability-act-does-not-recognise-human-rights-violations.html (last accessed 23 Oct 2017).

95. “Scandinavian” welfare states include Denmark, Finland, Iceland, Norway, and Sweden. In these countries themselves, the term used is “Nordic”, as Iceland is a geographically separate entity and Finland not a part of the Scandinavian Peninsula (although it is geographically adjacent to Sweden and Norway and, with them, a part of the larger Fennoscandian Peninsula).

96. Eg., Nelson RH. Lutheranism and the Nordic Spirit of Social Democracy: A Different Protestant Ethic. Aarhus: Aarhus University Press; 2017.

97. Milne R. True Finns split holds lesson for Europe’s populists. Financial Times 16 June 2017; available at https://www.ft.com/content/fe376512-51b8-11e7-bfb8-997009366969 (last accessed 23 Oct 2017).

98. Chazan G. AfD leader splits with party after German election breakthrough. Financial Times 25 Sept 2017; available at https://www.ft.com/content/96dee78c-a1c2-11e7-b797-b61809486fe2 (last accessed 23 Oct 2017).

99. “Smaller auxiliary parties” can mean all the other parties mentioned in the text, including the Green League, which may currently be moving up in the world, and, in addition, the Swedish People’s Party of Finland and the Christian Democrats.

100. The Social Democrats and the Left Alliance have been depicted in Figure 7 as socialist parties, but experience shows that they can expand to the political right (upwards in the figure) if this becomes politically profitable.

101. Blue and white are the colors of the Finnish flag, and political color divisions tend to be along the lines of blue and white (conservative and right-wing) against red (radical and left-wing). This is in contradiction with the right-left color scheme in the United States, where Republicans are red and Democrats blue. In Scandinavian (or Nordic) terms, both main parties in the United States are libertarian, and outside the map of the acceptable welfare state realm.

102. See, e.g., Takala T, Häyry M, eds. Genetic Information (special issue). Theoretical Medicine and Bioethics 2001;22:403–91; Häyry M, Takala T, eds. The Future of Value Inquiry. Amsterdam and New York: Rodopi; 2001; Häyry M, Takala T, eds. Scratching the Surface of Bioethics. Amsterdam and New York: Rodopi; 2003; Takala T, Häyry M, eds. Dissecting Bioethics (special section) Cambridge Quarterly of Healthcare Ethics 2004;13:3–46; Häyry M, Herissone-Kelly P, Takala T, eds. Bioethics and Social Reality. Amsterdam and New York: Rodopi; 2005; Häyry M, Takala T, Herissone-Kelly P, eds. Ethics in Biomedical Research: International Perspectives. Amsterdam and New York: Rodopi; 2007; Häyry M, Chadwick R, Árnason V, Árnason G, eds. The Ethics and Governance of Human Genetic Databases: European Perspectives. Cambridge: Cambridge University Press; 2007; Takala T, Herissone-Kelly P, Holm S, eds. Cutting through the Surface: Philosophical Approaches to Bioethics. Amsterdam and New York: Rodopi; 2009; Häyry M, Takala T. Herissone-Kelly P, Árnason G, eds. Arguments and Analysis in Bioethics. Amsterdam and New York: Rodopi; 2010; Takala T, ed. Philosophical Issues in Neuroethics (special section). Cambridge Quarterly of Healthcare Ethics 2010;19:161–229; Launis V, Takala T. Neuroethics (special issue). TRAMES: Journal of Humanities and Social Sciences 2011;15:123–212; Häyry M, Takala T, eds. Best Practice in Conceptual Philosophical Bioethics (special issue). Bioethics 2014; available at http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291467-8519/homepage/best_practice_in_conceptual_philosophical_bioethics.htm (last accessed 23 Oct 2017); Häyry M, Takala T, eds. The Role of Philosophy and Philosophers in Bioethics (special issue). Bioethics 2014; available at http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291467-8519/homepage/the_role_of_philosophy_and_philosophers_in_bioethics.htm (last accessed 23 Oct 2017); Takala T, Häyry M, eds. The State and Future of Philosophical Bioethics (special section). Cambridge Quarterly of Healthcare Ethics 2015;24:135–213; Häyry M, Takala T, eds. Global Ethics as Theory and Practice (special issue). Journal of Global Ethics 2015;11:65–125; Häyry M, Takala T, eds. Responsibility, Vulnerability, Dignity, and Humanity (special section). Cambridge Quarterly of Healthcare Ethics 2016;25:171–271; Takala T, Häyry M, eds. Synthetic Biology: Ethical and Philosophical Challenges (special section). Cambridge Quarterly of Healthcare Ethics 2017;26:183–277.

103. See note 14, Halila 2003.

104. Halila, R, Lötjönen, S. Why shouldn’t children decide whether they are enrolled in nonbeneficial medical research? American Journal of Bioethics 2003;3:35–6.CrossRefGoogle ScholarPubMed

105. Halila, R. Assessing the ethics of medical research in emergency settings: How do international regulations work in practice? Science and Engineering Ethics 2007:13:305–13.CrossRefGoogle ScholarPubMed

106. Saarni, SI, Halila, R, Palmu, P, Vänskä, J. Ethically problematic treatment decisions in different medical specialties. Journal of Medical Ethics 2008;34:262–7.CrossRefGoogle ScholarPubMed

107. Halila, R. Evaluation of the work of hospital districts’ research ethics committees in Finland. Journal of Medical Ethics 2014;40:866–8.CrossRefGoogle ScholarPubMed

108. Clarkeburn H. How to Teach Science Ethics? (PhD thesis). University of Glasgow; 2000; available at http://theses.gla.ac.uk/2852/1/2000clarkeburnphd.pdf (last accessed 23 Oct 2017).

109. Clarkeburn H. A test for ethical sensitivity in science. Journal of Moral Education 2002;31:439–53; Clarkeburn HM, Downie JR, Gray C, Matthew RGS. Measuring ethical development in life sciences students: A study using Perry’s developmental model. Studies in Higher Education 2003; 28:443–56.

110. Clarkeburn, H, Freeman, M. To plagiarise or not to plagiarise: An online approach to improving and motivating honest academic writing. International Journal of Management Education 2008;6:21–33.Google Scholar

111. Clarkeburn, H, Mustajoki, A. Tutkijan arkipäivän etiikka [The everyday ethics of researchers]. Tampere: Vastapaino; 2007.Google Scholar

112. Mustajoki, H, Mustajoki, A. A New Approach to Research Ethics: Using Guided Dialogue to Strengthen Research Communities. London: Routledge; 2017.Google Scholar

113. See note 10, Ahola-Launonen 2016.

114. E.g., Pihlainen A. Hyvä, ihanteellisuus ja epäitsekkyys arvo- ja arvostuskäsityksinä terveydenhuollon koulutuksessa ja työelämässä (The good, idealism, and unselfishness as value and valuation conceptions in healthcare education and practice, PhD thesis). University of Tampere; 2000; available at http://tampub.uta.fi/bitstream/handle/10024/66988/951-44-4763-8.pdf?sequence=1 (last accessed 23 Oct 2017).

115. Information available at https://www.thl.fi/en/web/thlfi-en (last accessed 23 Oct 2017).

116. Hemminki, E, Tupasela, A, Jallinoja, P, Aro, AR, Snell, K, Sihvo, S. Finnish people’s attitudes towards biomedical research and its sponsorship. Genomics, Society and Policy 2009;5:67–79.CrossRefGoogle Scholar

117. Tupasela A, Sihvo S, Snell K, Jallinoja P, Aro A, Hemminki E. Attitudes toward biomedical use of tissue sample collections, consent, and biobanks among Finns. Scandinavian Journal of Public Health 2010;38:46–52.

118. Hemminki E, Virtanen J, Veerus P. Varying ethics rules in clinical research and routine patient care – research ethics committee chairpersons’ views in Finland. Health Research Policy and Systems 2014;12:15; available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987656/ (last accessed 23 Oct 2017).

119. Hemminki E. Research ethics committees in the regulation of clinical research: Comparison of Finland to England, Canada and the USA. Health Research Policy and Systems 2016;14(1):5; available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750216/ (last accessed 23 Oct 2017).

120. Eg., Harva U. Hyvä ja paha: Praktisen etiikan ongelmia [Good and bad: Problems in practical ethics]. Helsinki: Otava; 1978; Airaksinen T. Mitä on käytännöllinen etiikka [What is practical ethics]. Ajatus 1983;40:87–99; Pietarinen J. Ihminen ja metsä: Neljä perusasennetta [People and forest: Four fundamental attitudes]. Silva Fennica 1987;21:323–31; Häyry M, Häyry H. Rakasta kärsi ja unhoita: Moraalifilosofisia pohdintoja ihmiselämän alusta ja lopusta [Love suffer and forget: Moral philosophical reflections on the beginning and end of human life]. Helsinki: Kirjayhtymä; 1987; Häyry M. Critical Studies in Philosophical Medical Ethics (doctoral thesis). Helsinki: University of Helsinki; 1990; Häyry H. The Limits of Medical Paternalism. London: Routledge; 1991.

121. Eg., Häyry M. Categorical objections to genetic engineering – A critique. In: Dyson A, Harris J, eds. Ethics and Biotechnology. London: Routledge; 1994:202–15; Häyry M, Takala T. Cloning, naturalness and personhood. In: Thomasma DC, D.N. Weisstub DN, Hervé C, eds. Personhood and Health Care. Dordrecht: Kluwer Academic Publishers, 2001; 281–98.

122. Takala T. Genes, Sense and Sensibility: Philosophical Studies on the Ethics of Modern Biotechnologies (doctoral thesis). Turku: University of Turku; 2000.

123. Launis, V. Multidimensional Bioethics: A Pluralistic Approach to the Ethics of Human Biotechnology (doctoral thesis). Turku: University of Turku; 2001.Google Scholar

124. Siipi H. Naturalness, Unnaturalness and Artificiality in Bioethical Argumentation (doctoral thesis). Turku: University of Turku; 2005.

125. Aaltola E. Animal Individuality: Cultural and Moral Categorisations (doctoral thesis). Turku: University of Turku; 2006.

126. Ahteensuu M. In Dubio Pro Natura? A Philosophical Analysis of the Precautionary Principle in Environmental and Health Risk Governance (doctoral thesis). Turku: University of Turku; 2008.

127. Takala, T. What is wrong with global bioethics? On the limitations of the four principles approach. Cambridge Quarterly of Healthcare Ethics 2001;10:72–7.CrossRefGoogle ScholarPubMed

128. Takala T. Utilitarianism shot down by its own men? Cambridge Quarterly of Healthcare Ethics 2003;12:447–54.

129. Häyry M. A defense of relativism. Cambridge Quarterly of Healthcare Ethics 2005;14:7–12.

130. Takala T. Demagogues, fire fighters or window-dressers? Who are we and what should we be? Cambridge Quarterly of Healthcare Ethics 2005;14:385–8.

131. See note 9, Häyry, Takala 2007.

132. See note 10, Takala 2009a.

133. See note 10, Takala 2009b.

134. Häyry M. Is transferred parental responsibility legitimately enforceable? In: Simonstein F, ed. Reprogen-Ethics and the Future of Gender. Dordrecht: Springer; 2009:135–49.

135. Häyry M. What do you think of philosophical bioethics? Cambridge Quarterly of Healthcare Ethics 2015;24:139–48.

136. Takala T. Get to the point! Philosophical bioethics and the struggle to remain relevant. Cambridge Quarterly of Healthcare Ethics 2015;24:149–53.

137. See note 11, Häyry, Takala 2005.

138. Takala T, Häyry M. Benefiting from past wrongdoing, human embryonic stem cell lines, and the fragility of the German legal position. Bioethics 2007;21:150–9.

139. Takala T. Setting a dangerous precedent? Ethical issues in human genetic database research. Medical Law International 2007;8:105–37.