Hofling – yes or no?

Task 3:

Read the information about Hofling’s experiment.

Here is some extra information beyond the text book pages you have been given.


So the question you need to answer is this:

Would you let someone wanting to repeat Hofling’s 1966 experiment today carry out the same procedure? Considering in what ways might Hofling be considered either ethical or not?

You must justify your answer by explaining by referring to the ethical guidelines you have been given to look at. You may reference other guidelines you have researched.

You should explain the guideline and how Hofling’s procedure both shows and does not show this.

35 Responses to Hofling – yes or no?

  1. Nick Jenkins says:

    Hofling’s experiment is ethical in some ways but not in others, for example there was no informed consent: the nurses were not told what was going to happen, which on the face of it seems unethical.
    However the nurses had to not be told what was going on, because the experiment wanted to see their natural reaction which is only possible without informed consent and it would have affected the results because one of the four scenarios was the nurse had to give an overdose of the drug and if the nurses had known it was a placebo they would give it to the patient, knowing it would cause them no harm.
    This does mean deception also occured because nurses weren’t told information including that the drug is a placebo and that the call to the doctor is scripted.

    The nurses were debriefed after the experiment had finsihed, debriefing is seen to be an ethical practice.

    It can be argued that the participants were not protected from mental/emotional harm because it the nurse decided to give they drug they may be upset by the fact they done something against the rules and maybe even worry about losing their job, however there is no way to have solved the issue of this emotional harm, this like the lack of consent, was unethical but an important part of the experiment.

    The experiment was ethical due to the face that everything was confidental.

    The participants were not aware of their right to leave the study, which is seen as unethical, but multiple scenarios would end the experiment, including the nurse seeking advice or becoming upset.
    I feel that because there were some many ways to end the experiment and be doing any of thsose things you withdraw yourself from the experiment I don’t think that it was unethical.

    I would let someone repeat the experiment because I believe that in order do improve our understanding of things we need to do things that are in a bit of an ethical/moral ‘grey area’.

  2. Ollie Tycer says:

    I would allow someone to repeat Hofling’s experiment today.

    The ethics of the experiment are, overall, reasonable however some parts of the experiment could be viewed as unethical. The nurses involved in the field experiment did not give informed consent to be part of the experiment which automatically leads to deception of the participants which could be considered unethical when in a place such as a hospital where workers would already be in a stressful environment in the modern day. However the nurses did receive a full debrief to ensure there was no lasting distress or confusion about the call from an unknown doctor, or the realisation of ‘overdosing’ a patient in their care. The experiment would stop if the nurse became distressed or refused to administer the drug, this would increase the protection of the participant which makes the experiment more ethical, however some would say that it is also unethical for making the nurse distressed in the first place. The confidentiality of nurses is also kept making the experiment more ethical aswell.
    One of the problems with the ethics of the experiment is that the nurses do not know of their right to withdraw from the experiment which could be problematic, although there are many ways for the experiment to end, for example getting advice or refusing to administer the drug, I also believe this is not unethical as if the nurse was truly distressed she could have also hung up the phone, and this could also happen if the experiment was repeated today.

    I would also look at the ethics of the patients most of the experiments guidelines speak only of the nurses welfare, I would also hope the patient would either be an ‘actor’ who is fully briefed on the experiment or a patient with minor injury or illness that the placebo will not effect, who is also fully briefed. Otherwise a sudden increase in the medicine taken or being talked to by a distressed nurse could also cause distressed to a real life patient who is not briefed/debriefed.

    However, if this issue is addressed then I see no ethical problems with the experiment as the unethical deception is needed to observe real behaviour and a full debrief should more than make up for any distress caused by the phone call from an unknown ‘doctor’. Therefore I would let it be repeated in a hospital today.

  3. Eleanor Buckle says:

    I would let someone repeat Hoflings experiment, this is because overall i believe that the experiment was done mostly ethically, even though this was not the case one hundred percent of the time.
    The nurses did not give their consent to be part of the experiment, which could be seen as unethical. But if this had been the case i believe that the results wouldn’t be reliable because they wouldn’t be acting naturally and therefore wouldn’t act the same. This is shown in the questionnaire, which shows that when people know other people will be judging their actions they won’t do what they would probably do when some one was watching if it wasn’t in line with the rules of the hospital, which the experiment was not. So therefore i believe that this fact makes not asking for the nurses consent more acceptable because there was no other way to do the experiment and get reliable results. Also they’re not being put in situations that are that different to the everyday circumstances they have to put up with in their everyday lives.
    Also because of not knowing they were part of an experiment, this means that they couldn’t withdraw from it. But they did end the experiment if the nurse became distressed, this meant that the nurses were protected because they weren’t making them do anything they weren’t comfortable with.
    Other from this the experiment was in line with ethical guidelines. No one was physically harmed in the experiment, which meant that everyone involved was protected. The nurses were also quickly debriefed, and therefore they can understand the experiment and why they were being investigated, in the debriefing none of the nurses were distressed, which shows that the study was acceptable. Also no names were used so they were kept confidential, this is also good because it protects the participants.
    Therefore i think that the experiment is acceptable and should be allowed to be repeated.

  4. Chloe Durant says:

    Considering all the ethical and non-ethical sides to the investigation, I would allow someone to repeat Hofflings experiment.
    In some ways his experiement is ethical. To get good results, the nurses could not be asked to consent because the results would then be false. However the participants were debriefed and given full information on what they took part in after the investigation was done.
    As long as the patients in the hospital are consented and debriefed without deception, and the nurses information is kept under conifdetiality and they can pull out their input after debriefing, then the experiment is OK to carry out.
    However his experiment is unethical in some ways. If the nurses do give the medicine, they could then doubt their skills of being a nurse and have mental issues within them selves from then on about giving out medicine. Also the placebo tablets would have to be completely un-harmful to the patients; not effecting them in anyway.
    Hofling’s experiment does not state whether the patients being given the information where consented properly or not, and does not state whether the nurses could pull out or not at the end. If the experiment was to be carried out again, these factors would have to be met to be as ethical as possible.

  5. Louise Hudson says:

    I would let someone repeat Hofling’s 1966 experiment today as it follows most of the ethical guidelines and doesn’t leave any long last emotional and or psychological affects.
    Firstly the experiment did not need any informed consent as the event could of easily happened in the nurse’s everyday life as they ‘stated that it was a fairly common occurrence’. Also the experiment would not have worked in the same way if the nurses knew that they were being tested. This is proved by the contrasting data from the questionnaires and the experiment as in the questionnaires all the nurses baring 2 said they would not have given the medication. However in the experimental situation all the nurses baring 1 did start to give the medication.
    Furthermore withdrawal from the experiment was easily available however was not obvious. If the nurses got emotional or just refused to give the medication and ended the call then they were withdrawn from the experiment.
    Another ethical guideline Hofling’s experiment has complied with is debriefing the participant. All the nurses were informed about their part in the investigation within 30 minutes.
    Additionally the participants of the study were protected from any harm. The patients could not of received an overdose as the medication was a placebo. The nurses were not put in a situation that included more physical or mental harm than of that in ordinary life.
    One of the problems with the experiment is that it does involve deception and the fact the nurses didn’t know about the study did mean that they didn’t know they could withdraw.
    In conclusion I would let someone repeat the experiment however I would make sure that the nurses received support afterward incase they were emotional and were doubting their medical abilities. I would also make all the nurses results confidential and allow them to withdraw their results after the debriefing.

  6. Emma Brown says:

    I would let someone who wanted to repeat Hofling’s experiment today go ahead although there are a few ethical guidelines that have not been met.

    The nurses did not give consent to be in the experiment, but this was for a reason because if they had known they were part of an experiment the results would not be reliable as they would not act normally. Consequently as they did not know they were part this experiment they were unaware that they could withdraw from taking part in the investigation. However they did end the experiment when the nurse complied and to issue the medicine, refused consistently to give the medicine, went to get advice, became upset or the call went on for more than 10 minutes. Straight after that a researcher was on hand to debrief the nurse within half an hour to make sure the nurses understand what they researching and why.

    The experiment did not use any names to keep confidentiality and protect the participants. Also from this experiment the nurses are not being protected from physical or mental harm as they could be embarrassed, frightened or offended, they could also question their ability to keep their job as a nurse. The patients in this experiment are not harmed because the medicine was a placebo meaning that it would do nothing to affect them.

    To conclude, this experiment gives good results to see what would happen if the nurses were to be in that situation, it would also give patients reassurance that they are in the hands of a responsible nurse although some ethical guidelines have not been met.

  7. Charlie Adams says:

    Although there are arguments both for and against, I would allow someone to repeat Hofling’s experiment today.

    The ethical issues surrounding the experiment all focus on the well being of the nurse. Firstly if the experiment were completely ethical, the nurse would have to have given informed consent, however this would have created a scenario in which the nurse would have known what the researchers were looking for, thereby changing the results and making them unreliable.
    The second ethical issue is shown during the call. If the nurse (who has not been told about the experiment) becomes emotional or stressed this is affecting her welfare. However, this is counter-acted by Hofling ensuring that there was a researcher on hand to debrief the nurses within half an hour of the end of the call.
    Additionally the participants are protected from any harm during the experiment. The debriefing is close to the end of the experiment meaning the risk of long term psychological effects is significantly lower. Also the patients that the nurses treated were never under any threat, as the pills were not real medicine.

    In conclusion I would let someone repeat the experiment because it meets enough ethical guidelines to make it safe and there is low risk of long term side effects.

  8. Lois Kerswell says:

    I would let someone repeat Hofling’s experiment today due to the fact that it follows most ethical guidelines and although some are broken, these have no long-lasting effect.
    Firstly, an ethical guideline is broken in the sense that the nurses did not give informed consent, at the time of the study they were not aware of it and what they were contributing to. Although I think that gaining informed consent would have affected the outcome of the situation because the nurses would have behaved differently knowing they were under observation. I believe that it was okay to go on without informed consent seeing as the nurses were not put in an abnormal situation that wouldn’t have happened in normal life, with the nurses stating it was ‘a fairly common occurrence’. The subjects were also made aware of the study at the soonest possible point without affecting the results. I think that if they were made aware of the study before they took part, and it wouldn’t have affected the results, most would not have withdrawn because they would most likely be happy to contribute to a study which will allow helpful knowledge about how to better the place in which they work.
    The participants were debriefed at the end of the study and their role in the research was explained to them. This is ethical and I think that it would actually give the nurses insight into the nurse-physician relationship, highlighting to them that maybe they should re-consider the blind trust and obedience that they have when physicians give instructions, as it was made apparent at the end of the study that all nurses knew they should not have admitted the medicine and 11 were aware that the dosage could endanger the life of the patient.
    Taking part in the study may cause distress at multiple points. The nurse may have become distressed while on the phone to the doctor or become doubtful and upset. This was dealt with by following ethical guidelines by having the experiment end if this occurred. The participants were protected from physical and emotional harm during the experiment. However after the experiment had ended they may still be emotionally hurt – feeling that their actions were wrong and their professionalism and quality as a nurse is under scrutiny. This could cause longer lasting distress, although I think this is acceptable because it could easily happen in real life if it occurred outside of the study, and in the long-run I think it would help the workplace by making it clearer to the subjects that they should think more about their actions when other’s lives are involved.
    Confidentiality was maintained, with the nurses not being named, there were only statistical numbers used. This is ethical because they would not then be personally targeted for their unprofessional actions or breaking of hospital policy despite the fact they admitted to knowing they were breaking it. It was not made clear if the nurses could withdraw but I think this would have been a necessary option if the study was repeated.
    All facts taken into consideration I believe that Hofling’s experiment is acceptable to be repeated. Although there is slight deception and no informed consent, conducting the experiment otherwise would have altered the results and the study would not be as accurate. If the study was to be repeated I think it would be necessary to tell the patients involved that it is a study and obtain informed consent from them. Also the option to withdraw should be given to the nurses at the end of the experiment. Other than this, I believe the study follows all ethical guidelines to the best of its ability without changing the outcome. Any unethical elements of the experiment are outweighed by the information gained by the study because the data could help understand the actions taken by nurses in hospitals and help to solve any issues which may cause problems and endanger lives in the future.

  9. Beth Entwisle says:

    Yes I would let someone repeat Hofling’s experiment today due to no actual harm coming of the experiment. Although the nurses did not give informed consent or get a debrief, if this did happen the result of the experiment would not be a true reflexion of how a nurse responds to a doctor who is breaching the hospital policies and therefore the aim of the investigation would not be met.
    Another factor which was not taken into response when designing the investigation was the protection of participants. It would have been possible for the nurse to become slightly distressed with what is being asked of him/ her. This is one factor which some may say makes the experiment unethical. Nevertheless, I believe this distress would not be long lasting and therefore was an acceptable sacrifice for the investigation.
    The experiment did keep the nurses anonymous and therefore complied with this in particular guideline in ensuring the investigation was ethical.
    However, there is also some other factors that Hofling did not comply with. For example, deception. As a part of the experiment the nurses where all tricked into thinking they were in a difficult situation where as in reality it was a trick. However, it would be impossible to carry out this experiment without deceiving he nurses. Due to this it is essential to consider if it would be for the best to hide what is actually happening in order to record a realistic reaction.
    Finally, the nurses never had the chance to withdraw from the investigation due them believing it was a real life situation. This is therefore another reason why the experiment maybe consider unethical.
    In conclusion, I would still say that it is OK to repeat the experiment as it shows if nurses are following the policies in hospitals. It could have been anyone on the phone and in a real life situation it may cause a deathly over dose to a patient from someone untrained ringing up. The investigation shows if more procedures need to be taken in to consideration in hospital and could overall save lives. Therefore a bit of deception and short lasting distress is worth it.

  10. Jess Jobson says:

    I would let someone today repeat Hofling’s experiment.

    Hofling follows some, but not all of the ethical guidelines in psychological research. This suggests that he is both ethical and unethical, with the overall conclusion lying with an individual’s values. I believe Hofling to be unethical in regards to informed consent. This is because the nurses did not agree to take part in the experiment, or in fact know that an experiment was ever taking place. However, this guideline had to be breached in order to get accurate results, as the questionnaire outlined. The questionnaire proved that people are likely to lie when knowing that they are being monitored or judged. This shows that informed consent would have been ineffective, as the test results would have been biased. On the basis of debriefing, Hofling is considered to be ethical because all nurses that were involved in the experiment were given a full debrief after it had concluded to ensure that there was no emotional stress caused. This was also how Hofling protected the participants and confirmed that no mental harm was produced. He also made sure that no physical harm was caused to the patients by using all placebo tablets. There was deception in the investigation, as no informed consent was given, which led to this. However, deception was also necessary in order for Hofling to obtain accurate results. Hofling was ethical in the sense that confidentiality was kept because no details about any of the participants were revealed during or after the experiment. Withdrawal from the experiment was also not possible because participants were unaware that an experiment was taking place.

    Overall, I believe Hofling’s experiment to be, in most parts, ethical because he protected the participants’ safety in every way that was possible whilst obtaining accurate results. He followed all ethical guidelines that he could without making the investigation biased.

  11. Emma Jackson says:

    I would let someone repeat Hofling’s experiment today if it meant that the new research would have more benefits in the long run.

    In my opinion, the biggest concern in this experiment was that the nurses had not given informed consent, and so the procedure may not be viewed as completely ethical. However, if the nurses were aware that they were being observed, it could have influenced the results and so would not have been a fair test. With the nurses unaware of what was really going on they would have been able to act naturally without feeling pressured to do the right thing, and the results would be more reliable, so I think that it was better that the nurses were unaware of the situation. Also, the nurses were debriefed at the end of the process so they were not permanently deceived. This part of the experiment could also help the nurses become more conscious of the correct rules of how to behave and remember that they should always check instructions in future situations.

    I think the experiment definitely had more advantages then disadvantages, for example, no-one was harmed in the experiment, so the participants were always protected. There were also restrictions as to how long the process could last and if the nurses consistently refused to give the medicine or became upset the experiment was immediately stopped, which also protected the participants from becoming too uncomfortable.

    Overall, I think that Hofling tried to follow as many ethical guidelines as possible, which did not affect the results. I would let someone repeat the experiment, mainly because nobody was harmed in the procedure, but also because it can protect future patients from being harmed from unreliable nurses.

  12. Jess Hill says:

    I would let Hofling’s experiment be repeated today as I believe that is considered ethical as the main ethical guidelines are covered.
    Although there was no informed consent given to the nurses, this is understandable as this would change the behaviour of the nurses which was create unreliable results. Also the experiment appeared to be something that happens in everyday life to the nurses as following orders received by phone was ‘a fairy common occurrence’ for the nurses, although it is against hospital rules. Also the patient should be informed, if the experiment was repeated, as he/she is also being used in the investigation and may want to withdraw from the investigation.
    The participants were all debriefed at the end of the study by a researcher within half an hour. There is no evidence shown in the article of the depth of the debrief but as the nurses were asked about the dosage limits for astroten i believe all details were explained so the nurses were fully aware of the aim of the investigation.
    However i believe that the protection of participants was not acceptable. As some nurses ‘became emotionally upset’ and could have been distressed by the situation, because of the difficult decision that they had to make. Therefore if Hofling’s experiment was to be repeated, support would need to be provided to any nurses. Possibly if any nurses became severely distressed the debrief should be given straight away to prevent mental harm to the participants.
    The deception in the experiment is the whole phone call as the participant is wrongly informed about a patient needing the drug. However this is the aim of the investigation and it is used to avoid demand characteristics which could happen if any other methods were used, or if the participants realised that it was an experiment the results may be different.
    Hofling’s experiment does not show any details about the guideline confidentiality, but if the experiment was repeated the name of nurses and data from the experiment should be kept anonymous. If the hospital received the data the nurses jobs could be lost due to the experiment.
    As there was no informed consent, the participants were not aware of the investigation and therefore could not withdraw. However the participants could choose to not follow the instructions of the doctor on the phone and therefore not take part. Although it does not show any opportunity to withdraw data at the end of the experiment.
    I believe that if some ethical issues where updated then Hofling’s experiment would be acceptable to be repeated.

  13. Grace Durbridge says:

    Considering the ethical issues, there are some that are covered and others which are not however i think it would be interesting to repeat Hofling’s experiment so i would let someone repeat it. The main reason for this is that no one was harmed or hugely distressed as a result of the experiment.
    The nurses did not give informed consent. This was probably necessary due to the circumstances as if they had been told fully what the experiment was testing then they may have reacted differently. They were neither given a debriefing and had no option to withdraw from the investigation but, similarly, if the nurses had known that they were involved in the research then they may have chosen to respond differently.
    Although this may not appear ethical, the guidelines state that if it would be part of something that could ‘easily happen to the in everyday life’ then it fits into the guidelines. As nurses the situation was very natural but relied on them choosing the right thing and following the hospital rules. Also their identity was kept anonymous so this made it confidential.
    Likewise, the nurses may have been slightly misled and deceived as they were unaware of the experiment that was taking place however this was all included in the nature of the experiment.
    The results of the nurses that participated may have been surprising and alarmed us that perhaps nurses should remember their duty and the hospital rules but, in my opinion, as humans we sometimes doubt our ability and knowledge when another person who is more powerful orders us to do something which is wrong. Furthermore everyone makes mistakes or breaks a rule based on their instincts and although some may see what the nurses did was irresponsible and dangerous i think its unfair for us to judge them on their decision if we have never had to make a big decision like that before.
    I think if Hofling’s experiment was repeated there may be some different results but a few of the ethical aspects may have to be altered to fit the guidelines and make the experiment more ethically acceptable.

  14. Cameron Wilcox says:

    Yes, i would let someone go ahead with the experiment. However there are some ethical issues, but in my opinion these issues do not cause people massive distress or psychological harm.
    Although the subjects didn’t actually give consent to take part in the research this doesn’t over step the bounds of ethics, because they are subjected to a scenario ‘that could easily happen to them in everyday life.’ As a result of this the subject will not have been told about anything about the research, including risks etc.
    The subjects were given a full debrief “within half an hour” of the experiment which is very ethical because it means they will be provided to stress for a lower amount of time.
    The participants were protected throughout the experiment as the “risk of harm [was] no greater than it is in ordinary life.”
    The participants were deceived this was in order to avoid demand characteristics. The participants were deceived as little as possible but the ethical guidelines do say that deception may not cause the participants distress, the experiment did cause some distress, which may not be ethically viable. However the true nature of the experiment was revealed as soon as possible.
    Those involved in the experiment were never named; which is ethical because it matches with the confidentiality area of the guidelines.
    There was also no time that the participants could withdraw from the study this was because they were not aware at any point that they were being observed which is not ethically viable.
    Overall i would say that Hofings experiment does not cause the participants distress above what they may experience in everyday life, i would therefore let someone carry out the experiment again provided they updated some of their methods so they are more ethically viable.

  15. Charlotte Janes says:

    Despite the ethical issues that come with Hofling’s experiment, I would let someone carry out the experiment today because the results it would provide are not only interesting, but give us useful information.
    As already said, there are some ethical guidelines that haven’t been kept and so could make the experiment appear quite unethical. For example, the participants did not give informed concept. However, this was in the interest of getting a useful results, and other aspects of the guideline such as ensuring that what was happening in the experiment could happen in real life were used, making the experiment more ethical as the experience could have happened in real life. Again, the protection of participants guideline was also broken because being told to give an overdose may have distressed some of the nurses, which would have made the experiment unethical, especially as the experiment does say that it should end if a nurse becomes “emotionally upset” suggesting that Hofling was aware that the nurses could become distressed.
    Aditionally, deception was used as the nurses were misled to think that it was not a test. However, this was in the interest of getting a realistic and useful result. Also, there was little deception and the true nature of the researcher was revealed as early as possible, making the test fairly ethical.

    It is arguable that the withdrawal from the investigation guideline was kept. This is because although the nurse could not withdraw from the experiment as a whole because the experiment was not known of by them, they could choose to not carry out the action of the experiment. However I think that the experiment leans more towards breaking the guideline than keeping it, making the experiment less ethical in this part.

    On the other hand, the nurses were given a debrief as soon as the test was over, “within half an hour” which makes the test more ethical as it means the nurses do not spend a long time worrying or getting more upset by believing that the test was actually reality.
    A second way the experiment kept to the guidelines was through keeping with the Confidentiality guideline. No names were given and so there was a great amount of confidentiality kept, making this guideline shown very well.

    In conclusion I would allow the experiment to be repeated as it is not totally unethical, and where it is unethical the participants will not be caused any large, or long term amount of distress. Also, the potential results would be very useful information about today’s society, especially if compared to the results from 1966.

  16. Ben Moses says:

    I would let someone repeat Hoflings experiment even though it has a few ethical problems. such as not asking for the nurses and students who were taking part to give there permission to go through with the experiment.the was also some deception as they didn’t know what was actually going to happen with the experiment.
    However the researchers had to do it this way otherwise the nurses wouldn’t have followed their own instinct as they would know that the researchers would know what they did, which would make them think about what they are doing and do it by the books rather than what they were told would be the best for the patient.
    The researchers have set up a debriefing session to help with and distress caused by the experiment. which is also good as it will stop any long term distress for the nurses.
    The researchers also cover every angle so that if the nurses did end up agreeing to do what they were told to do then it wouldn’t cause any harm to the patient as they used fake pills in the real bottle for the drugs.

  17. Cora McGrath says:

    I would not let someone repeat the experiment under the same conditions in this present day because certain aspects of it are not ethical. There are 6 guidelines that are meant to be followed in relation to ethics when conducting an experiment. These are: informed consent; debriefing; protection of participants; deception; confidentiality and whether the participants can withdraw from the investigation. This experiment involves having to deceive the nurses involved as they are unaware that they are subjects of an experiment, it does not protect the participants adequately from emotional harm in that because it is a life or death situation some of the nurses are likely to be quite traumatised at having to make the decision, the nurses are not given a chance to withdraw from the investigation because they are not aware it is taking place and because they are unaware they are subjects of the experiment they cannot give informed consent. There is no mention of the issue of confidentiality; however, the one ethical consideration that is contained in the experiment is debriefing as the nurses are told within half an hour after the experiment about the investigation.
    To summarise, this experiment has been shown to be not ethically sound in its current form. If it were to be repeated there would need to be many adaptations so it would fit the ethical guidelines of today. If it was to be repeated it would have to be quite different from the original experiment.

  18. Sara Moore says:

    I would not let someone repeat this experiment today because there are many ethical problems with this investigation.
    There is deception in the experiment as the nurses do not know they are subjects in an investigation, although I think that if they were told the results would be very different as they would be more aware in what they are doing. The nurses could not give informed consent because they didn’t know about the investigation, therefore would also not be able to withdraw from it because they did not know they were part of it. Another reason why I would not allow this to be repeated is that the protection of participants is not taken into consideration. The nurses will feel guilty for agreeing to give the patient the pill after realising the consequences it may have, although it was a placebo drug they will be very concerned as to what they are being asked to do in real life situations because they wont know if they are taking part in another study or not. This could cause them mental harm as they will always think back to the investigation and how they responded to it.
    A good thing about this investigation is that it debriefs the nurses at the end which allows them to finally know that they have been part of an experiment.

  19. Bradley Palmer says:

    I would allow somebody to repeat Hofling’s 1966 experiment today, however I would make sure that the subjects had given informed consent of some kind, even if deception had to be used to some degree to prevent the nurses from behaving differently I feel that it would be necessary for the success of the experiment.

    I feel that Hofling’s experiment would be absolutely fine to carry out today based on the fact that the patient who the overdose is being given to is not any any real danger at all (the drug is a fake placebo). This would be protecting the subject as it wouldn’t leave them with a guilty conscience which could lead to depression but it would also obviously protect the patient.

    I think that Hofling’s experiment isn’t unethical by any means as it isn’t actually harming anybody at all. The only factor which could come into play which could suggest the experiment is slightly unethical would be the fact that the nurse/subject may feel that the decision is too much to handle and she may begin to panic or feel that the emotional strain is too much; being asked to kill someone is a massive decision to make and it can make people feel very uncomfortable understandably. This would go against ‘protection’ of the subject taking part in the experiment and this would also be deception as you’re creating a false order with no real consequences, however as they’re led to believe that it’s the truth it would be unfair and distressing for them.

  20. Gimhani Gunasekara says:

    I would allow someone to repeat Hofling’s 1966 experiment. It would give very useful information about nurses and how they take on their role.

    Of course there are many ethical reasons to this experiment. Firstly, in does not give informed consent to the nurses. So they are unaware of the procedure and this of course goes against the ethical guidelines. All participants have a right to know about an experiment. Secondly, there is very little protection of participants. It states in the experiment that some nurses became emotionally upset. This suggests that it can cause distress and mental harm which is highly wrong. It is difficult as the nurses have to decide whether to kill a patient or not. There is deception in this experiment and although this is wrong, you would not want the nurses to know what the researchers are looking for. This would restrict them from acting naturally and showing what they would do in the real situation. Participants are not allowed to withdrawal from the investigation either. This is quite unethical as they should have a right to do this in the study.

    However, as this is an experiment the astroten is fake and is actually a placebo so no patients are harmed in the process. This shows that the experiment is quite fair. It suggests that the nurses would not be killing and so they would not be mentally harmed or physically harmed after the procedure. The participants also receive a debrief so they are informed at the end of the study about the research. Confidentiality is also maintained throughout the study. All names and personal information are kept anonymous.

    Overall, I believe that the experiment should be allowed to be repeated as it can show if nurses are aware of dosages and if they go against professional standards. It can also show whether nurses would make the effort of questioning why a Doctor would be giving such orders.

  21. Jack Smith says:

    I would personally allow someone to repeat Hofling’s experiment today. However I would like a few changes to be made. These would make it more ethical and reduce the stress put on the nurses.

    The original experiment had some ethical parts but was mostly unethical. The ethical parts include a debrief within half an hour, confidentiality for the nurses and a fair amount of protection for the participants. The debrief follows the ethical guidelines perfectly and so would be fine today. The confidentiality is also fine as the nurses names are not used and so they are kept anonymous. Finally the nurses are protected as giving a patient some medication is not dangerous. However if the medication did have a affect on a patient it may put them at risk.

    The Unethical parts include: Informed consent, deception and withdrawal from an investigation. These are either not addressed or not fully taken care of. For informed consent the nurses are not fully informed of the full experiment, this can be okay with the guidelines as long as it involves an everyday situation. For the deception the nurses where not misguided to much but some changes may need to be made. For example have then administer a drug that any patient could need. Finally for withdrawal from an investigation it is possible for the nurses to pull out of the written part but not so from the practical part. Also it is not mentioned if they have a chance to withdraw their data from the research.

    Therefore I believe that with a few adjustments Hofling’s experiment can be made ethical and could be repeated in the present day.

  22. Emma Gregory says:

    I would let someone repeat Hofling’s experiment in the present day. However it would need some adjustments to fit the modern ethical criteria.

    Hofling’s experiment was unethical as they did not have any ethical guidelines in 1966. But now it is seen that it was wrong for him to not get informed consent from the nurses involved as it gave them no choice to opt out, although if they had of been told the aim of the investigation they may not have acted in the way they did and the results would not have been so conclusive. When the participants were told that it was an experiment many found it distressing, however if an option was available for them to withdraw their results from the experiment it would be seen as ethical and less upsetting.

    Nevertheless, Hofling’s experiment was well planned and controlled. He made sure that he could stop the investigation if it got too stressful for the nurse; for example if the nurse ‘became emotionally upset’. He also made a placebo pill so that there was no danger for the patient and therefore no emotional guilt or distress for the nurse. The nurses also received a debriefing within half an hour which made it less likely that the participants would feel anxious or guilty of what they had done.

    Consequently, I think that Hofling’s investigation could be repeated in the modern day with some adjustments, as it would also give a good insight to if the industry has changed over the past 40 years.

  23. Georgina O'Kane says:

    I would allow someone to repeat Hofling’s 1966 experiment as although there are some ethical issues, they can be dealt with and the experiment would produce very accurate results.

    The issue with the field experiment is that it does not follow the ethical guidelines very much. The whole concept of trying to pressure nurses into giving a patient an incorrect dosage of a drug could distress the participants, making the experiment unfair, and potentially unsafe for the participants; ignoring the guideline of protection of participants. As well as this, participants are deceived as they remain unaware that they are involved in an experiment and therefore the only participants that can give consent to be involved or withdraw from the experiment are the nurses partaking in the questionnaire section of the study.

    However, these issues do not appear to be overly problematic as at the end of the experimentt, the participants are debriefed on what they have just experienced. This means that they are eventually informed on the situation and any worries they had can be discussed and reassured. So even though the nurses are deceived, it is explained why they are so. As well as this, if the nurses has been able to give consent or withdraw,it would mean that they knew it was an experiment and manipulated their actions because of the knowledge they were being tested like the nurses doing the questionnaire.

    So overall I think the experiment would be acceptable to repeat in the present day as the participants are put in no real danger and are eventually aware that it was an experiment. The results produced by this would be accurate as they would be recording natural reaction to something and could be compared with the questionnaire results and see if the element of knowing that is was an experiment would produce different results.

  24. Georgiana Rowley says:

    I would say that yes, I would let someone repeat Hofling’s experiment.
    The lack of informed consent from the nurses could be seen as an issue, however the experiment wouldn’t have been likely to of provided sufficiently accurate data had the nurses been previously told. If researchers see this to be too problematic for an experiment nowadays, then one way to get around it would be to gain the consent from willing nurses at the beginning of a year. They would be told that they’re agreeing to be involved in an experiment which would take place at any point during the space of a year. This way consent is given but their demand characteristics wouldn’t be likely to affect the experiment as they wouldn’t know when the test would be occurring.

    The lack of consent does imply deception was a factor although necessary. The participants were wrongly informed for the purpose of the investigation however when a nurse became upset the experiment ended, implying Hofling aimed for them to be deceived as little as possible by avoiding any potential distress. A researcher was available for quick debriefs assuring that even if any distress was caused that it wouldn’t have been able to manifest. Which could be argued acted as a protection for the participants; the nurses weren’t exposed to any risks that they wouldn’t have otherwise encountered in their normal lifestyles.

    None of the nurse’s names were included; this confidentiality makes the experiment more ethical as they’re protected by remaining anonymous. This would also be a necessary factor if the experiment were to be replicated as patients involved may be insulted had they found out that their nurse willingly supplied them with a placebo overdose. To ensure the nurses involved don’t suffer from anxiety they should be told the experiment is anonymous in the almost instant debrief.
    As the nurses were unaware of the experiment taking place they were also therefore unaware of their right to withdraw at any point in time. Though it could be argued that the field experiment’s ability to be ended if a variety of circumstances were to occur acted as a withdrawal.

    One point which Hofling may not have considered is that there are sometimes ingredients in placebo capsules that people are allergic to. This would mean someone would have to be on hand to stop the nurse (once she’s already gotten the medication) prior to her reaching the patient.

    In conclusion, I would say that yes the Hofling 1966 experiment could be recreated as even though some of the aspects could be considered unethical. Overall his intentions were good and any data received merely helped the current society to realise certain issues needed rectifying.

  25. Katie Gower says:

    I would allow someone to repeat Hofling’s experiment because it the unethical issues are not too outrageous for example the if the nurse becomes emotionally upset it is most likely short term and will not cause any permanent emotional/psychological damage. Also the risk of damage was pushed even lower when “a researcher was in hand to debrief the nurse within half an hour”
    Although the nurses did not give confirmed consent, which does go against some ethical guidelines, the test wouldn’t have worked if they had known it was going to happen. The point was to take a nurse from their everyday life and place them in this situation for a spontaneous reaction; if the nurse had known about it they may have changed their answer or done something different to what they would have originally done to seem like the better person. So if the nurses had given consent then the experiment would have become invalid and unreliable.
    They were protected as no names were given and there were boundaries for example the experiment ended if the nurse became upset or if they were unsure and sought advice or if the conversation went on longer than 10 minutes.
    In conclusion I would allow is as it doesn’t cause any damage to either patient or nurse and it ensures reliable data.

  26. Rachael Speller says:

    Yes – however with some slight modifications. I would have removed the medication from its stand after all patients had received their medication and then replaced all of them with a placebo. This would ensure that no placebos were left behind by accident. This would then be swopped again at the end of the experiment. I believe that a researcher should be on hand immediately after the experiment to debrief the nurse as distress may not shown on camera.

    In many ways Hofling was not ethnical. For example the nurse was not informed consent, however this could have resulted in a change in the results of the experiment however perhaps another member of staff should have be informed for health and safety reasons. Protection of the nurse was only considered slightly as the nurse could have ignored the call or become distressed and concerned sooner and this may frighten her. However the nurse was given a debrief and deception wasn’t present. Confidentiality of the nurse was also considered as her name has not been mentioned, but on the other hand withdrawal from the investigation could have resulted in a worried or embarrassed participant.

    In conclusion I would let the experiment take place again, however considering the ethnical guidelines more closely.

  27. Jack Sewell says:

    Although there are some ethical issues with certain aspects of the Hofling experiment i believe that i would allow the experiment to be repeated today.

    The ethical issues surrounding the experiment is very simple. It is all about the psychological effects the test could have on the unsuspecting subjects. Although the nurses do have the option to withdraw from the experiment, they are unaware of this option and therefore, this is an ethical issue as the subjects have not had the experiment fully explained to them and this would imply deception was part of the planning of the Hofling experiment.

    Another issue is the lack of choice the nurses have. In some ways the nurses are forced to go against what they have learned and this could cause them distress which is not fair on them and can cause more ethical problems.

    However, they are measures to stop all of the possible problems occurring. For example the experiment would be stopped if the nurse became ’emotionally upset’ or repeatably refused to administer the medicine. These measures that have put in place in the Hofling experiment make it more suitable for use in the modern day as it reduces the ethical issues that surround the procedure.

    Results from the previous experiment would suggest that the experiment would be ok to run today as they tell us that many of the nurses were not distressed by the procedure and many just followed the instructions given by the unknown doctor.

    Overall, the measures put in place to counter the ethical issues convince me that it would be possible to run the experiment in the modern day.

  28. Emily Adams says:

    I think that the Hoflings experiment could be carried out today but would need some changes to make it more ethical. This is because the experiment in 1966 is mostly unethical as it is misleading to the nurses because they have not given informed consent or information that they could withdraw from the investigation if they wanted to. In addition, this shows that the investigation did not cover all of the ethical guidelines that would be apparent today, and therefore the procedure would need changing to ensure that all of the guidelines were covered.

    However, the procedure is slightly ethical because the nurses are given a debrief half an hour after the investigation by a researcher. This shows that if the nurse is emotionally upset then the debrief will inform them about what the procedure actually involved.

    On the other hand, the investigation also shows signs of deception because the researchers didn’t tell the nurses complete information so during the procedure, the nurses could became distressed because they might feel that the have given medication in an unsafe dosage. Therefore, this study should be continued today, but with some changes so that the ethical guidelines are followed and that the subjects are fully informed about what they are agreeing to do.

  29. Kayleigh Read says:

    Yes, i think that i could be carried out today in order to see if anything has changed from the past, but i would keep the data confidential from he public eye as it may cause legal battles and may cost jobs for the nurses and doctors. It may also cause distress to patients within hospital whom are taking certain medicine.

    Hofling’s experiment may be seen as unethical as it is exposing that some patients may be receiving overdose from nurses and some patients may then refuse, it could also be seen as unethical as during the debrief the nurse may feel distressed. There may have been deception withing the experiment as nurses and doctors may have thought they just had to answer the questionnaire, but without this the experiment would not have worked.

    However Hofling’s experiment can be seen as ethical as the nurses have given consent into the investigation as they answered the questionnaires and all information was given in the debrief. During the report there were no names mentioned meaning that subjects were given confidentiality.

    I believe that Hofling’s experiment was ethical as the subject were full aware of them taking part in a experiment.

  30. Alexander Thomson says:

    I wouldn’t want someone to repeat Hofling’s 1966 experiment today as it may discourage nurses from doing their job and destroy the trust between Nurses and doctors. The real problem lies with the doctors, and in the study the Nurses just appear to be trying to get on with their jobs. In my opinion, the study isn’t realistic. In the real world the Nurses wouldn’t dare go against a senior figure such as a doctor, as they would trust them. Therefore, as I said before, the real issue of responsibility lies with the doctor, and I don’t think that the nurse should be held accountable.

    However, In some ways, Hofling’s experiment could be seen as Ethical as it is using a placebo, and obviously the weak nurses that would act in the wrong way can be identified and warned/fired from employment, meaning it is for the greater good.

    Despite this, I still think that the cons outweigh the pros as the same result of the study can be achieved if nurses are taken out of the equation and if doctors are studied instead. Therefore I wouldn’t want this study to be repeated.

  31. Isaac Daar says:

    I would not let someone carry out the Hofling experiment today as it was too unethical. Firstly the experiment did not allow the nurses any informed consent, this means they were wrongly put in an experiment which could cause them stress without agreeing. As well this distress they were subjected meant there was no protection of participants and this means the nurses were but in emotional danger. Further more the patients were not told either that they were in an experiment and if at the time they realised they had been given an overdose this would have also caused them distress as well. Also at no point were the nurses given any chance to withdraw from the experiment which they might have wanted to having known they were in the study. Finally it could have put the nurses off their jobs or ruined their relationship with the doctors causing problems after the experiment had concluded, this would have caused problems at the hospitals where it took place.

    Having said all this the experiment did take some ethical measures in the experiment like debriefing the nurses at the end of the study, these precautionary measures would have reduced the distress caused to nurses. Also it did make good use of deception to get good results, however this may have been used too far and again may have caused distress when the nurses found out. However none of this surpasses the fact that high levels of stress would have been put on nurses when the experiment was conducted and so that’s why it couldn’t be carried out today.

  32. Ellie Wilmot says:

    I would allow someone wanting to carry out Hoflings experiment from 1966 carry it out again today.

    This is because I believe it provides the person/persons carrying out the experiment with reliable results. If the nurses were told about the experiment before it was undertaken they would not have acted their normal selves and probably would have reacted differently. They would react differently because they knew they were being listened to and watched and so wouldn’t have done maybe what they would have done if they didn’t know they were being watched and they thought it was just them and the ‘doctor’ on the phone who knew what was going on. Informed consent is the understanding that participants must be told by the researcher what the research is all about and then the researcher must ask for their consent to take part. Although some may say this is ethically wrong because the nurses would not be able to give informed consent, if they did give consent then the experiment in a way would have no point to it because its wouldn’t be a true representation of the nurses normal behavior. You can see this is actually true from looking at the results of the questionnaire where the nurses knew the situation compared with the experimental situation where the nurses did not know. All the nurses who took a questionnaire which asked them what they would do if they were put in the situation said that they would not give the medication to the patient which is very interesting when you look and see that 21 out of the 22 nurses used in the experimental situation started to give the medicine to the patient. So although there was deception involved in this experiment when it comes to the nurses used for the actual situation, it was deception that was possibly worth it to get an accurate result. The fact that the nurses wouldn’t have known that they were part of an experiment means that they wouldn’t be able withdraw from it. But the experiment in 1966 was ended before the nurse actually gave the patient any medication so the nurses were protected because they didn’t actually do anything that could mentally or physically harm them.

    At the end of the experiment the nurses were debriefed to explain to them fully what the experiment was about so that they were clear as to what had happened. The nurses also were never named in Hoflings experiment and so would not be if somebody repeated the experiment today.

  33. Shannon Hewitt says:

    I would let someone repeat Hofling’s experiment today because it follows most of the guidelines for an ethical experiment. However one of the guidelines that were broken are that the nurses had no informed consent of the experiment that they participated in-which I deem it acceptable as it is set in an everyday situation. The researchers benefit from not informing the nurses by stopping them nurses behaving differently when observed, such as rethinking their actions and treating patients differently which would make the results inaccurate. Deception also occurred as the nurses were not told that the medication was in fact a placebo. However the experiment is ethical as the identity’s of the nurses and hospitals were kept confidential, so that the nurses don’t feel targeted for breaking hospital policy- even though they knew that they were breaking it. Also the nurses were debriefed within ‘half an hour’ to reduce psychological affects yet some may be distressed as they question their professionalism/ medical abilities as well as their trust in co-workers and authorities.
    In conclusion I would let someone repeat Hofling’s experiment today because it follows the majority of ethical guidelines, which will not impact the reliability of the results collected at the end of the experiment and does not have long-term psychological affects.

  34. Joe Carter says:


    Hoflings experiment can be seen ethical in some ways but in others it can’t. Firstly, some guidelines were broken as the nurses weren’t given informed consent, so were unable to pull out of the experiment as they didn’t know they were part of it. The study is unrealistic because nurses would never take an order from an unknown voice over the phone. Aswell as this the protection of participants is poor because the researchers did not ensure that the nurses were free of any distress or mental harm, some may have come away feeling embarrassed from taking orders from an unknown doctor. Although they were giving the patient a placebo it may affect the nurses in the long term as they will fee frightened to take another order. Another reason the experiment is unacceptable is that it’s very deceiving, the nurses feel like they are doing their job responsibly when really some are doing the complete opposite. However this can be seen as a positive as the nurse’s skills are being tested and the doctors can assess which nurse is incapable. Although there is a debrief at the very end, some nurses will come away mentally scared.
    To summarise, I think the cons outweigh the pros in this experiment so therefore would not repeat it. I would advise that the subjects are given informed consent before even if deception had to be used in a way.

  35. Olly Blake says:

    I would let someone carry out this experiment today as I believe that it meets enough of the ethical guidelines to be accepted.

    Informed consent was not given which would be considered unethical, however if the nurses were told about the experiment it would of effected the results of the test, so informed consent is not required. This made the nurses’ reaction more genuine as they believed it was really happening. All nurses did recieve debriefs so they did not undergo any trauma as to why they were made to break the rules. Protection of participants was also there as what they had to do should not have had any adverse effects mentally. Possible stress was caused but that is all. There may have been deception but you could argue that because they had no idea that the experiment was taking place then they could not be decieved. All nurses identities were kept confidential in the study and no-one was named, however the nurses were denied Withdrawal from an investigation as they had no i dea they were being monitored.

    Overall I believe that the pros outweigh the cons and with a few minor changes to certain aspects of the investigation I believe it would be perfectly fine to carry out.

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