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Geiger J, Fuchs J, Starke M, Neumann M, Baber R, Nussbeck SY, Kiehntopf M, Specht C, Illig T, Hummel M, Jahns R. GBA/GBN-position on the feedback of incidental findings in biobank-based research: consensus-based workflow for hospital-based biobanks. Eur J Hum Genet 2023; 31:1066-1072. [PMID: 36732662 PMCID: PMC10474025 DOI: 10.1038/s41431-023-01299-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Incidental research findings pose a considerable challenge to hospital-based research biobanks since they are acting as intermediaries between healthcare and research. In a joint action the centralized biobank ibdw (Interdisciplinary Bank of Biomaterials and Data Wuerzburg) together with local authorities drafted a coherent concept to manage incidental research findings in full compliance with relevant ethical and data privacy regulations. The concept was developed and elaborated in close collaboration with the German Biobank Alliance (GBA). Comprehensive documentation of all steps guarantees the traceability of the process. By a mandatory assessment of the findings prior to re-identification of the individual concerned, unnecessary measures can be avoided. The individual's "right not to know" is respected according to the stipulations of the informed consent. As a general principle any communication with the individual occurs exclusively through the hospital and by competent physicians with appropriate knowledge and communication skills. We propose this scheme as a blueprint for reporting workflows for incidental research findings at hospital-based biobanks.
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Affiliation(s)
- Joerg Geiger
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Joerg Fuchs
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Madeline Starke
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Neumann
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ronny Baber
- Leipzig Medical Biobank, University Leipzig, Leipzig, Germany
| | - Sara Y Nussbeck
- University Medical Center Goettingen, Central Biobank, UMG, Goettingen, Germany
| | - Michael Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), Jena University Hospital, Jena, Germany
| | - Cornelia Specht
- German Biobank Node, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michael Hummel
- German Biobank Node, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
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2
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Die zeitliche Dimension des Broad Consent. Ethik Med 2022. [DOI: 10.1007/s00481-022-00715-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
ZusammenfassungDie informierte Einwilligung von Teilnehmer:innen gilt in vielen Fällen als Voraussetzung auch für die rein datenbasierte medizinische Forschung. In diesem Kontext wird ein Modell der breiten Einwilligung (Broad Consent) diskutiert. In Deutschland hat die Medizininformatik-Initiative einen konkreten Vorschlag für deutsche Kliniken ausgearbeitet, der eine Gültigkeit der Einwilligung für einen Zeitraum von 30 Jahren vorsieht. Der vorliegende Artikel diskutiert vor diesem Hintergrund die Frage, wie der Anspruch der Informiertheit in dieser zeitlichen Perspektive einzuordnen ist. Die Praxis der Einwilligung wird dabei so verstanden, dass sie auf die Verwirklichung von Wohlergehen, persönlicher Souveränität und Vertrauen ausgerichtet ist. Eine anzunehmende Informationsasymmetrie zwischen Forschungsteilnehmenden, Forschenden, und datenspeichernden Institutionen wird dabei als spezifisches Kontextmerkmal herausgestellt. Um dieser Informationsasymmetrie in angemessener Weise zu begegnen, so die These, ist eine kontinuierliche Weitergabe von verständlich aufbereiteten Informationen an Forschungsteilnehmende notwendig, um die Wahrnehmung persönlicher Souveränität zu ermöglichen.
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3
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Martucci J, Prado Y, Rope AF, Weinmann S, White L, Zepp J, Henrikson NB, Feigelson HS, Hunter JE, Lee SSJ. An Examination of the Ethical and Legal Limits in Implementing "Traceback Testing" for Deceased Patients. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:818-832. [PMID: 36883408 PMCID: PMC10009393 DOI: 10.1017/jme.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This paper examines the legal and ethical aspects of traceback testing, a process in which patients who have been previously diagnosed with ovarian cancer are identified and offered genetic testing so that their family members can be informed of their genetic risk and can also choose to undergo testing. Specifically, this analysis examines the ethical and legal limits in implementing traceback testing in cases when the patient is deceased and can no longer consent to genetic testing.
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Affiliation(s)
- Jessica Martucci
- HISTORY AND SOCIOLOGY OF SCIENCE DEPARTMENT, UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, USA
| | - Yolanda Prado
- DEPARTMENT OF TRANSLATIONAL AND APPLIED GENOMICS, CENTER FOR HEALTH RESEARCH, KAISER PERMANENTE NORTHWEST, PORTLAND, OR, USA
| | - Alan F Rope
- CENTER FOR HEALTH RESEARCH, KAISER PERMANENTE NORTHWEST; PORTLAND, OR AND GENOME MEDICAL; SOUTH SAN FRANCISCO, CA, USA
| | - Sheila Weinmann
- DEPARTMENT OF TRANSLATIONAL AND APPLIED GENOMICS, CENTER FOR HEALTH RESEARCH, KAISER PERMANENTE NORTHWEST, PORTLAND, OR, USA
| | - Larissa White
- INSTITUTE FOR HEALTH RESEARCH, KAISER PERMANENTE, DENVERCO, USA
| | - Jamilyn Zepp
- DEPARTMENT OF TRANSLATIONAL AND APPLIED GENOMICS, CENTER FOR HEALTH RESEARCH, KAISER PERMANENTE NORTHWEST, PORTLAND, OR, USA
| | - Nora B Henrikson
- KAISER PERMANENTE WASHINGTON HEALTH RESEARCH INSTITUTE, SEATTLEWA, USA
| | | | - Jessica Ezzell Hunter
- DEPARTMENT OF TRANSLATIONAL AND APPLIED GENOMICS, CENTER FOR HEALTH RESEARCH, KAISER PERMANENTE NORTHWEST, PORTLAND, OR, USA
- GENOMICS, ETHICS, AND TRANSLATIONAL RESEARCH PROGRAM, RTI INTERNATIONAL, RESEARCH TRIANGLE PARK, NC, USA
| | - Sandra Soo-Jin Lee
- DIVISION OF ETHICS, DEPARTMENT OF MEDICAL HUMANITIES AND ETHICS, COLUMBIA UNIVERSITY, NEW YORK, NY, USA
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4
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Vander Wyst KB, Olson ML, Bailey SS, Valencia AM, Peña A, Miller J, Shub M, Seabrooke L, Pimentel J, Olsen K, Rosenberg RB, Shaibi GQ. Communicating incidental and reportable findings from research MRIs: considering factors beyond the findings in an underrepresented pediatric population. BMC Med Res Methodol 2021; 21:275. [PMID: 34865631 PMCID: PMC8647358 DOI: 10.1186/s12874-021-01459-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/27/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The application of advanced imaging in pediatric research trials introduces the challenge of how to effectively handle and communicate incidental and reportable findings. This challenge is amplified in underserved populations that experience disparities in access to healthcare as recommendations for follow-up care may be difficult to coordinate. Therefore, the purpose of the present report is to describe the process for identifying and communicating findings from a research MRI to low-income Latino children and families. METHODS Latino adolescents (n = 86) aged 12-16 years old with obesity and prediabetes underwent a research MRI (3 Tesla Philips Ingenia®) as part of a randomized controlled diabetes prevention trial. The research MRIs were performed at baseline and 6 months to assess changes in whole-abdominal fat distribution and organ fat in response to the intervention. An institutional pathway was developed for identifying and reporting findings to participants and families. The pathway was developed through a collaborative process with hospital administration, research compliance, radiology, and the research team. All research images were reviewed by a board-certified pediatric radiologist who conveyed findings to the study pediatrician for determination of clinical actionability and reportability to children and families. Pediatric sub-specialists were consulted as necessary and a primary care practitioner (PCP) from a free community health clinic agreed to receive referrals for uninsured participants. RESULTS A total of 139 images (86 pre- and 53 post-intervention) were reviewed with 31 findings identified and 23 deemed clinically actionable and reportable. The only reportable finding was severely elevated liver fat (> 10%, n = 14) with the most common and concerning incidental findings being horseshoe kidney (n = 1) and lung lesion (n = 1). The remainder (n = 7) were less serious. Of youth with a reportable or incidental finding, 18 had a PCP but only 7 scheduled a follow-up appointment. Seven participants without a PCP were referred to a safety-net clinic for follow-up. CONCLUSIONS With the increased utilization of high-resolution imaging in pediatric research, additional standardization is needed on what, when, and how to return incidental and reportable findings to participants, particularly among historically underrepresented populations that may be underserved in the community. TRIAL REGISTRATION Preventing Diabetes in Latino Youth, NCT02615353.
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Affiliation(s)
- Kiley B Vander Wyst
- College of Graduate Studies, Midwestern University, Glendale, AZ, USA
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Smita S Bailey
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Ana Martinez Valencia
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
| | - Armando Peña
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA
| | - Jeffrey Miller
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Mitchell Shub
- Division of Gastroenterology, Phoenix Children's Hospital, Phoenix, AZ, USA
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Lee Seabrooke
- Office of Research, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Janiel Pimentel
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Kiri Olsen
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA
- Office of Research, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Robert B Rosenberg
- Office of Research, Phoenix Children's Hospital, Phoenix, AZ, USA
- Division of Pediatric Critical Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St, Phoenix, AZ, 85004, USA.
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, AZ, USA.
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA.
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5
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Shining a Light also Casts a Shadow: Neuroimaging Incidental Findings in Neuromarketing Research. NEUROETHICS-NETH 2021. [DOI: 10.1007/s12152-021-09463-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractRapid growth in structural and functional brain research has led to increasing ethical discussion of what to do about incidental findings within the brains of healthy neuroimaging research participants that have potential health importance, but which are beyond the original aims of the study. This dilemma has been widely debated with respect to general neuroimaging research but has attracted little attention in the context of neuromarketing studies. In this paper, I argue that neuromarketing researchers owe participants the same ethical obligations as other neuroimaging researchers. The financial resources available to neuromarketing firms and the social value of neuromarketing studies should command greater attention to the elucidation and management of incidental findings. However, this needs to be balanced against finite resources available within most public health systems.
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6
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Esquerda M, Palau F, Lorenzo D, Cambra FJ, Bofarull M, Cusi V, Interdisciplinar En Bioetica G. Ethical questions concerning newborn genetic screening. Clin Genet 2020; 99:93-98. [PMID: 32779199 DOI: 10.1111/cge.13828] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
Abstract
Newborn screening is a public health strategy used to identify certain diseases in the first days of life and, therefore, facilitate early treatment before the onset of symptoms. The decision of which diseases should be included in a screening goes beyond the medical perspective, including reasons for public health and health economics. There are a number of characteristics to include a disease in the screening, such as that the disorder must be a significant health problem, the natural history of the disease must be well known, a feasible and accurate test must be available, there must be a treatment that is most effective when applied before the onset of clinical symptoms and a health system must be in place that is capable of performing the procedure and subsequent monitoring. Currently, newborn screening programs are currently based on the use of biochemical markers that detect metabolites, hormones or proteins, but recently, the availability of new technology has allowed the possibility of a genetic screening. In addition to technical problems, the possibility of neonatal screening also presents a number of ethical problems. We identified and discussed six areas of particular concern: type of illness, overdiagnosis or overtreatment, information management and informed consent, data confidentiality and protection, justice and legal regulation.
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Affiliation(s)
- Montserrat Esquerda
- Institut Borja de Bioètica (Universitat Ramon LIuII); Universitat de Lleida - Facultat de Medicina, Barcelona, Spain
| | - Francesc Palau
- Hospital Sant Joan de Deu, Barcelona, Spain.,Fundacion Sant Joan de Deu, Barcelona, Spain
| | - David Lorenzo
- Institut Borja de Bioètica (Universitat Ramon LIuII); Sant Joan de Deu School of Nursing, Barcelona, Spain
| | - Francisco Jose Cambra
- Institut Borja de Bioètica (Universitat Ramon LIuII); Hospital Sant Joan de Deu, Barcelona, Spain
| | | | - Victoria Cusi
- Institut Borja de Bioètica (Universitat Ramon LIuII), Barcelona, Spain
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7
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Ewuoso C. Ubuntu philosophy and the consensus regarding incidental findings in genomic research: a heuristic approach. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:433-444. [PMID: 32335796 DOI: 10.1007/s11019-020-09953-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study adopts a heuristic technique to argue the thesis that a set of norms rooted in the African philosophy of Ubuntu can usefully supplement current research guidelines for dealing with incidental findings discovered in genomic research. The consensus regarding incidental findings is that there is an ethical obligation to return individual genetic incidental findings that meet the threshold of analytic and clinical validity, have clinical utility, and are actionable, provided that research contributors have not opted out from receiving such information. This study outlines the hurdles that may hinder the integration of this consensus in mainstream clinical practice, and shows how an ethical theory from the global south may be used to address the same. This will advance the field of ethical, legal and social issues of personalized medicine by providing exposure to the under-represented African perspective on the ethical, legal, and social issues of genomics.
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Affiliation(s)
- Cornelius Ewuoso
- Department of Philosophy, University of Johannesburg, Johannesburg, South Africa.
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8
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Ibuki T, Yamamoto K, Matsui K. Differences in Conceptual Understanding of the "Actionability" of Incidental Findings and the Resultant Difference in Ethical Responsibility: An Empirical Study in Japan. AJOB Empir Bioeth 2020; 11:187-194. [PMID: 32615058 DOI: 10.1080/23294515.2020.1784308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The issue of incidental findings encountered in medical researches and in clinical practices becomes controversial in recent years. In what situations should researchers and clinicians disclose incidental findings to study participants or patients? According to previous studies, the concept of "actionability" is one of most important notions in determining the management of incidental findings, however, the understanding of this concept is also inconsistent among people and the inconsistency can affect the management of incidental findings. That is why we surveyed the difference in conceptual understanding of "actionability" for incidental findings with genomic researches in Japan. Methods: We conducted focus groups with individuals conducting genomics research or genetic testing at the National Centers in Japan, all of which are expected to contribute significantly to genomics research and subsequent clinical practice in Japan. Results: As far as our survey and analysis, there exists crucial discrepancy; one might consider that an "actionable" finding should be one that would be useful in treatment or prevention; another might consider if the finding could lead to a definitive diagnosis, it should be considered "actionable," regardless of the treatment potential of the disease; moreover another might considered that a finding that would lead to the opportunity to participate in a clinical trial was "actionable". Conclusion: Based on the present study which we conducted, we have examined thus far the concept of "actionability", which may influence the management of incidental findings. The present study revealed discrepancies in the understanding of this concept among the National Centers in Japan, which all bear similar expectations from society. And this difference in "actionability" would lead to variations in management of incidental findings.
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Affiliation(s)
- Tomohide Ibuki
- Faculty of Science and Technology, Tokyo University of Science, Noda-shi, Japan
| | - Keiichiro Yamamoto
- Department of Bioethics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kenji Matsui
- Division of Bioethics and Division of Bioethics and Healthcare Law, National Cancer Center Japan, Tokyo, Japan
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Abstract
Imaging research regularly yields incidental findings that may have personal medical or reproductive decision-making significance to study participants. It is widely assumed that researchers have a moral obligation to disclose at least some kinds of incidental findings to research participants. However, it is also a widely held view that researchers do not have a moral obligation to actively look for abnormalities irrelevant to the aims of their study. This paper challenges that assumption.
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Affiliation(s)
- Julian J Koplin
- Research fellow with the Biomedical Ethics Research Group, the Murdoch Children's Research Institute, and the Melbourne Law School at the University of Melbourne
| | - Martin R Turner
- Professor of clinical neurology and neuroscience in the Nuffield Department of Clinical Neurosciences at Oxford University and is an honorary consultant neurologist to the John Radcliffe Hospital in Oxford
| | - Julian Savulescu
- Uehiro chair in practical ethics at the University of Oxford, directs the Oxford Uehiro Centre for Practical Ethics, and codirects the Wellcome Centre for Ethics and Humanities
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10
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Saelaert M, Mertes H, Moerenhout T, De Baere E, Devisch I. Ethical values supporting the disclosure of incidental and secondary findings in clinical genomic testing: a qualitative study. BMC Med Ethics 2020; 21:9. [PMID: 32000764 PMCID: PMC6990492 DOI: 10.1186/s12910-020-0452-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/22/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Incidental findings (IFs) and secondary findings (SFs), being results that are unrelated to the diagnostic question, are the subject of an important debate in the practice of clinical genomic medicine. Arguments for reporting these results or not doing so typically relate to the principles of autonomy, non-maleficence and beneficence. However, these principles frequently conflict and are insufficient by themselves to come to a conclusion. This study investigates empirically how ethical principles are considered when actually reporting IFs or SFs and how value conflicts are weighed. METHODS A qualitative focus group study has been undertaken, including a multidisciplinary group of professionals from Belgian centres for medical genetics. The data were analysed thematically. RESULTS All eight Belgian centres participated in this study. Ethical values were frequently referred to for disclosure policies on IFs and SFs. Participants invoked respect for patient autonomy to support the disclosure of IFs and opt-out options for IFs and SFs, non-maleficence for the professional delineation of reportable IFs and opt-out options for IFs and SFs and (the particular scope of) beneficence for the mandatory reporting of actionable IFs, the delineation of reportable IFs and a current decline of actively pursued SFs. Professional assumptions about patients' genetic literacy were an important factor in the weighing of values. CONCLUSIONS In line with the traditional bioethical discourse, the mandatory reporting of actionable IFs might be interpreted as a "technological, soft paternalism". Restricting patients' choices might be acceptable, but then its motives should be valid and its beneficent outcomes highly plausible. Hence, the presuppositions of technological, soft paternalism - patients' inability to make informed decisions, normative rationality, the efficacy of beneficent outcomes and the delineated spectrum of beneficence - should be approached critically. Moreover, distributive justice should be considered an important value in the delineation of the current scope of the ethical debate on IFs and SFs. This study of guiding values may stimulate the debate on the ethical grounds for a solid policy on IFs and SFs internationally.
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Affiliation(s)
- Marlies Saelaert
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Corneel Heymanslaan 10 – Building 6K3, 9000 Ghent, Belgium
| | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Ghent, Belgium
| | - Tania Moerenhout
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Corneel Heymanslaan 10 – Building 6K3, 9000 Ghent, Belgium
- Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Elfride De Baere
- Center for Medical Genetics Ghent (CMGG), Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Ignaas Devisch
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Corneel Heymanslaan 10 – Building 6K3, 9000 Ghent, Belgium
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11
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Rosier M, Guedj M, Calvas P, Julia S, Garnier C, Cambon-Thomsen A, Muñoz Sastre MT. Attitudes of French populations towards the disclosure of unsolicited findings in medical genetics. J Health Psychol 2019; 26:1767-1779. [PMID: 31707852 DOI: 10.1177/1359105319886622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Next-generation sequencing techniques enable unsolicited findings to be detected. This discovery raises ethical questions concerning the return of these findings. Our study aimed to highlight the views of the general public, patients under supervision and health professionals concerning the acceptability of disclosing unsolicited results to patients. In total, 449 participants assessed scenarios, consisted of all combinations of three factors (patient's information and consent, prevention and treatment of the unsolicited disease and doctor's decision). The response profiles were grouped into six clusters. The participants took ethical aspects into account, but health professionals also considered the medical aspects to a greater extent.
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12
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Sheehan M, Thompson R, Fistein J, Davies J, Dunn M, Parker M, Savulescu J, Woods K. Authority and the Future of Consent in Population-Level Biomedical Research. Public Health Ethics 2019; 12:225-236. [PMID: 32082417 PMCID: PMC7020771 DOI: 10.1093/phe/phz015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Population-level biomedical research has become crucial to the health system’s ability to improve the health of the population. This form of research raises a number of well-documented ethical concerns, perhaps the most significant of which is the inability of the researcher to obtain fully informed specific consent from participants. Two proposed technical solutions to this problem of consent in large-scale biomedical research that have become increasingly popular are meta-consent and dynamic consent. We critically examine the ethical and practical credentials of these proposals and find them lacking. We suggest that the consent problem is not solved by adopting a technology driven approach grounded in a notion of ‘specific’ consent but by taking seriously the role of research governance in combination with broader conceptions of consent. In our view, these approaches misconstrue the rightful location of authority in the way in which population-level biomedical research activities are structured and organized. We conclude by showing how and why the authority for determining the nature and shape of choice making about participation ought not to lie with individual participants, but rather with the researchers and the research governance process, and that this necessarily leads to the endorsement of a fully articulated broad consent approach.
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Affiliation(s)
| | - Rachel Thompson
- School of School of Sport & Exercise Science, Swansea University
| | - Jon Fistein
- Inter-Disciplinary Ethics Applied Centre (IDEA), Leeds University
| | | | | | - Michael Parker
- Wellcome Centre for Ethics and Humanities, Oxford University and Ethox, Oxford University
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13
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Brelsford KM, Ruiz E, Hammack CM, Beskow LM. Improving Translation and Cultural Appropriateness of Spanish-Language Consent Materials for Biobanks. Ethics Hum Res 2019; 41:16-27. [PMID: 31541540 PMCID: PMC6856797 DOI: 10.1002/eahr.500028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A growing proportion of prospective research participants in the United States speak limited or no English. We conducted cognitive interviews with native Spanish speakers to test Spanish-language translations of simplified and traditional biobank consent forms. Comprehension was generally high and did not differ by form. Most of those who received the simplified form felt it contained the right amount of information, compared with fewer than half of those who received the traditional form. Qualitative results allowed us to identify overarching issues related to tone, formality, and voice that may affect prospective participants' trust and willingness to participate. Certain characteristics of written Spanish are seemingly at odds with recommended actions to simplify consent forms; thus, even when significant empirical effort has been expended to develop simplified consent materials in English, additional work is needed to ensure the accuracy, comprehensibility, and cultural-congruence of Spanish-language translations.
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Affiliation(s)
- Kathleen M Brelsford
- Research assistant professor in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center
| | - Ernesto Ruiz
- Postdoctoral fellow in the Department of Family and Community Medicine at Meharry Medical College
| | - Catherine M Hammack
- Associate in health policy in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center
| | - Laura M Beskow
- Professor and the Ann Geddes Stahlman chair in medical ethics in the Center for Biomedical Ethics & Society at Vanderbilt University Medical Center
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14
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Gronowski AM, Budelier MM, Campbell SM. Ethics for Laboratory Medicine. Clin Chem 2019; 65:1497-1507. [PMID: 31434657 DOI: 10.1373/clinchem.2019.306670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/08/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Laboratory medicine, like other areas of medicine, is obliged to adhere to high ethical standards. There are particular ethical issues that are unique to laboratory medicine and other areas in which ethical issues uniquely impact laboratory practice. Despite this, there is variability in ethics education within the profession. This review provides a foundation for the study of ethics within laboratory medicine. CONTENT The Belmont Report identifies 3 core principles in biomedical ethics: respect for persons (including autonomy), beneficence (and its corollary nonmalfeasance), and justice. These core principles must be adhered to in laboratory medicine. Informed consent is vital to maintain patient autonomy. However, balancing patient autonomy with the desire for beneficence can sometimes be difficult when patients refuse testing or treatment. The use of leftover or banked samples is fundamental to the ability to do research, create reference intervals, and develop new tests, but it creates problems with consent. Advances in genetic testing have created unique ethical issues regarding privacy, incidental findings, and informed consent. As in other professions, the emergence of highly contagious and deadly infectious diseases poses a difficult ethical dilemma of helping patients while protecting healthcare workers. CONCLUSIONS Although many clinical laboratorians do not see or treat patients, they must be held accountable to the highest ethical and professional behavior. Recognition and understanding of ethical issues are essential to ethical practice of laboratory medicine.
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Affiliation(s)
- Ann M Gronowski
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO;
| | - Melissa M Budelier
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Sheldon M Campbell
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
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Abstract
During the course of biomedical research, researchers sometimes obtain information on participants that is outside the aim of the study but may nonetheless be relevant to the participants. These incidental findings, as they are known, have been the focus of a substantial amount of discussion in the bioethics literature, and a consensus has begun to emerge about what researchers should do in light of the possibility of incidental findings. A consensus, however, is not necessarily correct. In this article, we address the common view that reporting of incidental findings should be based primarily on the possibility of medical benefit, factoring in the findings' validity, clinical actionability, and significance to health or reproduction. While such medical beneficence should not be discarded, the need to give proper attention to participants' autonomy, privacy, and interests (especially considering discussion of participants' right not to know) suggests an alternative standard for when to report incidental findings: even if they are of no direct medical benefit, incidental findings should be reported based on the extent to which the participant can be expected to comprehend the information. We will offer a preliminary defense of this alternative as best respecting participants' autonomy and privacy and promoting their interests. However, we acknowledge that the standard would face significant practical barriers, and these barriers lead us to propose a metaconsent addendum that would allow subjects to essentially waive the comprehension standard when resource or other constraints make meeting it impracticable.
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