2
|
Hug K, Johansson M. The ethics of withdrawal: the case of follow-up from first-in-human clinical trials. Regen Med 2016; 12:25-36. [PMID: 27976967 DOI: 10.2217/rme-2016-0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This paper aims to analyze whether patients should be allowed to veto research-related use of medical data collected during routine follow-ups after their withdrawal from first-in-human clinical trials. Forms of withdrawal are identified and it is argued that the right to withdraw might be limited to some of these. The paper concludes that if veto right is denied, then: the research participant should be informed about the potential use of his/her follow-up data in case of his/her withdrawal and consent to it; follow-up should not be initiated for research purposes; compulsory use of follow-up data should imply the use of data anyway collected, requiring no additional effort from the patient; and before deciding about the veto right, investigation of concerned patients' value preferences is needed.
Collapse
Affiliation(s)
- Kristina Hug
- Medical Ethics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, BMC I12, 22184 Lund, Sweden
| | - Mats Johansson
- Medical Ethics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, BMC I12, 22184 Lund, Sweden
| |
Collapse
|
4
|
Hermerén G. Human stem-cell research in gastroenterology: experimental treatment, tourism and biobanking. Best Pract Res Clin Gastroenterol 2014; 28:257-68. [PMID: 24810187 DOI: 10.1016/j.bpg.2014.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/11/2014] [Accepted: 02/21/2014] [Indexed: 01/31/2023]
Abstract
The growing interest in the possibility of applying stem-cell therapies to gastroenterological diseases is outlined. Some promising results have been reported, but more research is needed in view of the uncertainties and knowledge gaps that still exist. The ethical issues raised by this kind of research are then indicated and classified. Three problematic kinds of situation are outlined: experimental treatments, stem-cell tourism and biobanking. A four-question approach - which is not to be confused with the well-known four-principle approach introduced by Beauchamp and Childress - is described and applied to these three challenging situations. In conclusion, it is pointed out that the analysis of these situations illustrates the interplay between definitions, empirical research and ethics. They are interrelated and need to be integrated.
Collapse
Affiliation(s)
- Göran Hermerén
- Dept. of Medical Ethics, Lund University, Biomedical Center BMC I 12, 22184 Lund, Sweden.
| |
Collapse
|
5
|
Ogbogu U, Burningham S, Ollenberger A, Calder K, Du L, El Emam K, Hyde-Lay R, Isasi R, Joly Y, Kerr I, Malin B, McDonald M, Penney S, Piat G, Roy DC, Sugarman J, Vercauteren S, Verhenneman G, West L, Caulfield T. Policy recommendations for addressing privacy challenges associated with cell-based research and interventions. BMC Med Ethics 2014; 15:7. [PMID: 24485220 PMCID: PMC3914710 DOI: 10.1186/1472-6939-15-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/27/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The increased use of human biological material for cell-based research and clinical interventions poses risks to the privacy of patients and donors, including the possibility of re-identification of individuals from anonymized cell lines and associated genetic data. These risks will increase as technologies and databases used for re-identification become affordable and more sophisticated. Policies that require ongoing linkage of cell lines to donors' clinical information for research and regulatory purposes, and existing practices that limit research participants' ability to control what is done with their genetic data, amplify the privacy concerns. DISCUSSION To date, the privacy issues associated with cell-based research and interventions have not received much attention in the academic and policymaking contexts. This paper, arising out of a multi-disciplinary workshop, aims to rectify this by outlining the issues, proposing novel governance strategies and policy recommendations, and identifying areas where further evidence is required to make sound policy decisions. The authors of this paper take the position that existing rules and norms can be reasonably extended to address privacy risks in this context without compromising emerging developments in the research environment, and that exceptions from such rules should be justified using a case-by-case approach. In developing new policies, the broader framework of regulations governing cell-based research and related areas must be taken into account, as well as the views of impacted groups, including scientists, research participants and the general public. SUMMARY This paper outlines deliberations at a policy development workshop focusing on privacy challenges associated with cell-based research and interventions. The paper provides an overview of these challenges, followed by a discussion of key themes and recommendations that emerged from discussions at the workshop. The paper concludes that privacy risks associated with cell-based research and interventions should be addressed through evidence-based policy reforms that account for both well-established legal and ethical norms and current knowledge about actual or anticipated harms. The authors also call for research studies that identify and address gaps in understanding of privacy risks.
Collapse
Affiliation(s)
- Ubaka Ogbogu
- Faculties of Law and Pharmacy & Pharmaceutical Sciences, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
- Health Law Institute, Faculty of Law, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
| | - Sarah Burningham
- Health Law Institute, Faculty of Law, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
| | - Adam Ollenberger
- Health Law Institute, Faculty of Law, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
| | - Kathryn Calder
- cbcf Tumor Bank/Alberta Cancer Research Biorepository, Cross Cancer Institute, Rm 2312, 11560 University Avenue, Edmonton T6G 1Z2, Canada
| | - Li Du
- Health Law Institute, Faculty of Law, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
| | - Khaled El Emam
- Faculty of Medicine, University of Ottawa, CPCR, 401 Smyth Road, Ottawa K1H 8 L1, Canada
| | - Robyn Hyde-Lay
- Health Law Institute, Faculty of Law, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
| | - Rosario Isasi
- Centre of Genomics and Policy, Faculty of Medicine, and Department of Human Genetics, McGill University, 740, avenue Dr. Penfield, suite 5206, Montreal H3A 0G1, Canada
| | - Yann Joly
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, 740, avenue Dr. Penfield, suite 5206, Montreal H3A 0G1, Canada
| | - Ian Kerr
- Faculties of Law and Medicine, Department of Philosophy and School of Information Studies, University of Ottawa, 75 Laurier Avenue East, Ottawa K1N 6 N5, Canada
| | - Bradley Malin
- Schools of Medicine and Engineering, Vanderbilt University, 2525 West End Avenue, Nashville 37203, USA
| | - Michael McDonald
- W. Maurice Young Center for Applied Ethics, University of British Columbia, 2329 West Mall, Vancouver V6T 1Z4, Canada
| | - Steven Penney
- Health Law Institute, Faculty of Law, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
- Faculty of Law, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
| | - Gayle Piat
- Cell and Tissue Innovative Research Centre, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
| | - Denis-Claude Roy
- Centre de recherche Hôpital Maisonneuve-Rosemont, and Faculty of Medicine, University of Montreal, 5415 L’Assomption blvd, Montreal Quebec H1T 2M4, Canada
| | - Jeremy Sugarman
- Berman Institute of Bioethics and Department of Medicine, John Hopkins University, Baltimore Maryland 21205, USA
| | - Suzanne Vercauteren
- Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver V6T 1Z4, Canada
| | | | - Lori West
- Alberta Transplant Institute, Faculty of Medicine, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
- Faculty of Law and School of Public Health, University of Alberta, 116 Street and 85 Avenue, Edmonton T6G 2R3, Canada
| |
Collapse
|
6
|
Master Z, Claudio JO, Rachul C, Wang JCY, Minden MD, Caulfield T. Cancer patient perceptions on the ethical and legal issues related to biobanking. BMC Med Genomics 2013; 6:8. [PMID: 23497701 PMCID: PMC3599691 DOI: 10.1186/1755-8794-6-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 02/28/2013] [Indexed: 11/25/2022] Open
Abstract
Background Understanding the perception of patients on research ethics issues related to biobanking is important to enrich ethical discourse and help inform policy. Methods We examined the views of leukemia patients undergoing treatment in clinics located in the Princess Margaret Hospital in Toronto, Ontario, Canada. An initial written survey was provided to 100 patients (64.1% response rate) followed by a follow-up survey (62.5% response rate) covering the topics of informed consent, withdrawal, anonymity, incidental findings and the return of results, ownership, and trust. Results The majority (59.6%) preferred one-time consent, 30.3% desired a tiered consent approach that provides multiple options, and 10.1% preferred re-consent for future research. When asked different questions on re-consent, most (58%) reported that re-consent was a waste of time and money, but 51.7% indicated they would feel respected and involved if asked to re-consent. The majority of patients (62.2%) stated they had a right to withdraw their consent, but many changed their mind in the follow-up survey explaining that they should not have the right to withdraw consent. Nearly all of the patients (98%) desired being informed of incidental health findings and explained that the information was useful. Of these, 67.3% of patients preferred that researchers inform them and their doctors of the results. The majority of patients (62.2%) stated that the research institution owns the samples whereas 19.4% stated that the participants owned their samples. Patients had a great deal of trust in doctors, hospitals and government-funded university researchers, moderate levels of trust for provincial governments and industry-funded university researchers, and low levels of trust towards industry and insurance companies. Conclusions Many cancer patients surveyed preferred a one-time consent although others desired some form of control. The majority of participants wanted a continuing right to withdraw consent and nearly all wanted to be informed of incidental findings related to their health. Patients had a great deal of trust in their medical professionals and publically-funded researchers as opposed to profit-based industries and insurance companies.
Collapse
Affiliation(s)
- Zubin Master
- Alden March Bioethics Institute, Albany Medical College, 47 New Scotland Avenue, MC 153, Albany, NY 12208-3478, USA
| | | | | | | | | | | |
Collapse
|