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Corsico P. "It's all about delivery": researchers and health professionals' views on the moral challenges of accessing neurobiological information in the context of psychosis. BMC Med Ethics 2021; 22:11. [PMID: 33557813 PMCID: PMC7869514 DOI: 10.1186/s12910-020-00551-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
Background The convergence of neuroscience, genomics, and data science holds promise to unveil the neurobiology of psychosis and to produce new ways of preventing, diagnosing, and treating psychotic illness. Yet, moral challenges arise in neurobiological research and in the clinical translation of research findings. This article investigates the views of relevant actors in mental health on the moral challenges of accessing neurobiological information in the context of psychosis. Methods Semi-structured individual interviews with two groups: researchers employed in the National Health Service (NHS) or a university in England (n = 14), and mental health professionals employed in NHS mental health services (n = 14). This article compares results in the two groups (total n = 28). Results This article presents findings around three conceptual areas: (1) research ethics as mostly unproblematic, (2) psychosis, neurobiological information, and mental health care, and (3) identity, relationships, and the future. These areas are drawn from the themes and topics that emerged in the interviews across the two groups of participants. Researchers and health professionals provided similar accounts of the moral challenges of accessing—which includes acquisition, communication, and use of—neurobiological information in the context of psychosis. Acquiring neurobiological information was perceived as mostly unproblematic, provided ethical safeguards are put in place. Conversely, participants argued that substantive moral challenges arise from how neurobiological information is delivered—that is, communicated and used—in research and in clinical care. Neurobiological information was seen as a powerful tool in the process through which individuals define their identity and establish personal and clinical goals. The pervasiveness of this narrative tool may influence researchers and health professionals’ perception of ethical principles and moral obligations. Conclusions This study suggests that the moral challenges that arise from accessing neurobiological information in the context of psychosis go beyond traditional research and clinical ethics concerns. Reflecting on how accessing neurobiological information can influence individual self-narratives will be vital to ensure the ethical translation of neuroscience and genomics into mental health. Trial registration The study did not involve a health care intervention on human participants. It was retrospectively registered on 11 July 2018, registration number: researchregistry4255.
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Affiliation(s)
- Paolo Corsico
- Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
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Van eekelen JAM, Olsson CA, Ellis JA, Ang W, Hutchinson D, Zubrick SR, Pennell CE. Identification and genetic determination of an early life risk disposition for depressive disorder: Atypical stress‐related behaviour in early childhood. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/j.1742-9536.2011.00002.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- J. Anke M. Van eekelen
- Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Perth, Western Australia
| | - Craig A. Olsson
- Murdoch Children's Research Institute, Royal Childrens Hospital and the University of Melbourne (Psychological Sciences & Department of Paediatrics), Melbourne, Victoria
| | - Justine A. Ellis
- Environmental & Genetic Epidemiology Research, Murdoch Childrens Research Institute, The Royal Childrens Hospital, Melbourne, Victoria
| | - Wei Ang
- The School of Women's and Infants' Health, University of Western Australia at King Edward Memorial Hospital, Perth, Western Australia
| | - Delyse Hutchinson
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales
| | - Stephen R. Zubrick
- Telethon Institute for Child Health Research and Centre for Child Health Research, University of Western Australia, Perth, Western Australia
- Centre for Developmental Health, Curtin University of Technology, Perth, Western Australia, Australia
| | - Craig E. Pennell
- The School of Women's and Infants' Health, University of Western Australia at King Edward Memorial Hospital, Perth, Western Australia
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Manzini A, Vears DF. Predictive Psychiatric Genetic Testing in Minors: An Exploration of the Non-Medical Benefits. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:111-120. [PMID: 29230699 PMCID: PMC5897476 DOI: 10.1007/s11673-017-9828-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Abstract
Predictive genetic testing for susceptibility to psychiatric conditions is likely to become part of standard practice. Because the onset of most psychiatric diseases is in late adolescence or early adulthood, testing minors could lead to early identification that may prevent or delay the development of these disorders. However, due to their complex aetiology, psychiatric genetic testing does not provide the immediate medical benefits that current guidelines require for testing minors. While several authors have argued non-medical benefits may play a crucial role in favour of predictive testing for other conditions, little research has explored such a role in psychiatric disorders. This paper outlines the potential non-medical benefits and harms of psychiatric genetic testing in minors in order to consider whether the non-medical benefits could ever make such testing appropriate. Five non-medical themes arise in the literature: psychological impacts, autonomy/self-determination, implications of the biomedical approach, use of financial and intellectual resources, and discrimination. Non-medical benefits were prominent in all of them, suggesting that psychiatric genetic testing in minors may be appropriate in some circumstances. Further research needs to empirically assess these potential non-medical benefits, incorporate minors in the debate, and include normative reflection to evaluate the very purposes and motivations of psychiatric genetic testing in minors.
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Affiliation(s)
- Arianna Manzini
- Neuroscience, Ethics & Society Team, Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Ln, Oxford, OX3 7JX UK
| | - Danya F. Vears
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000 Leuven, Belgium
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Roberts LW, Kim JP. Receptiveness to participation in genetic research: A pilot study comparing views of people with depression, diabetes, or no illness. J Psychiatr Res 2017; 94:156-162. [PMID: 28719815 PMCID: PMC5621512 DOI: 10.1016/j.jpsychires.2017.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/28/2017] [Accepted: 07/02/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Genetic research in human health relies on the participation of individuals with or at-risk for different types of diseases, including health conditions that may be stigmatized, such as mental illnesses. This preliminary study examines the differences in attitudes toward participation in genetic research among individuals with a psychiatric disorder, individuals with a physical disorder, and individuals with no known illness. METHODS Seventy-nine individuals with a history of diabetes or depression, or no known illness, underwent a simulated consent process for a hypothetical genetic research study. They were then surveyed about their willingness to participate in the hypothetical study and their attitudes about future and family participation in genetic research. RESULTS Participants with and without a history of depression ranked participating in genetic and medical research as very important and indicated that they were likely to participate in the hypothetical genetics study. Expressed willingness to participate was generally stable and consistent with future willingness. Individuals less strongly endorsed willingness to ask family members to participate in genetic research. CONCLUSION Individuals with and without a history of mental illness viewed genetic and medical research favorably and expressed willingness to participate in real-time and in the future. Informed consent processes ideally include an exploration of influences upon volunteers' enrollment decisions. Additional empirical study of influences upon genetic research participation is important to ensure that volunteers' rights are respected and that conditions that greatly affect the health of the public are not neglected scientifically.
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Affiliation(s)
- Laura Weiss Roberts
- Stanford University, School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd., Stanford, CA 94304, United States.
| | - Jane Paik Kim
- Stanford University, School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd., Stanford, CA 94304
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Loch AA, Wang YP, Guarniero FB, Lawson FL, Hengartner MP, Rössler W, Gattaz WF. Patterns of stigma toward schizophrenia among the general population: a latent profile analysis. Int J Soc Psychiatry 2014; 60:595-605. [PMID: 24146365 DOI: 10.1177/0020764013507248] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Our purpose was to assess stigma toward schizophrenia in a representative sample of the Brazilian general population. METHODS The sample consisted of 1015 individuals interviewed by telephone. A vignette describing someone with schizophrenia was read, and four stigma aspects regarding this hypothetical individual were assessed: stereotypes, restrictions, perceived prejudice and social distance. Latent profile analysis searched for stigma profiles among the sample. Multinomial logistic regression was used to find correlates of each class. RESULTS Four stigma profiles were found; 'no stigma' individuals (n = 251) mostly displayed positive opinions. 'Labelers' (n = 222) scored high on social distance; they more often had familial contact with mental illness and more often labeled the vignette's disorder as schizophrenia. 'Discriminators', the group with the majority of individuals (n = 302), showed high levels of stigmatizing beliefs in all dimensions; discriminators were significantly older. 'Unobtrusive stigma' individuals (n = 240) seemed to demonstrate uncertainty or low commitment since they mostly answered items with the middle/impartial option. CONCLUSION Some findings from the international literature were replicated; however, familial contact increased stigma, possibly denoting a locally modulated determinant. Hereby, our study also adds important cross-cultural data by showing that stigma toward schizophrenia is high in a Latin-American setting. We highlight the importance of analyzing the general population as a heterogeneous group, aiming to better elaborate anti-stigma campaigns.
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Affiliation(s)
- Alexandre A Loch
- Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Yuan-Pang Wang
- Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Francisco B Guarniero
- Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fabio L Lawson
- Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Michael P Hengartner
- Department of General and Social Psychiatry, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of General and Social Psychiatry, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland Collegium Helveticum, a Joint Research Institute between the University of Zurich & ETH Zurich, Switzerland
| | - Wagner F Gattaz
- Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, School of Medicine, University of São Paulo, São Paulo, Brazil
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Olsson CA, Moyzis RK, Williamson E, Ellis JA, Parkinson-Bates M, Patton GC, Dwyer T, Romaniuk H, Moore EE. Gene-environment interaction in problematic substance use: interaction between DRD4 and insecure attachments. Addict Biol 2013; 18:717-26. [PMID: 22126256 DOI: 10.1111/j.1369-1600.2011.00413.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To investigate the combined effect of an exon III variable number tandem repeat in the dopamine receptor gene (DRD4) and insecure attachment style on risk for tobacco, cannabis and alcohol use problems in young adulthood. It was hypothesized that (1) individuals with 5, 6, 7 or 8 repeats (labelled 7R+) would be at increased risk for problematic drug use, and (2) risk for drug use would be further increased in individuals with 7R+ repeats who also have a history of insecure parent-child attachment relations. Data were drawn from the Victorian Adolescent Health Cohort Study, an eight-wave longitudinal study of adolescent and young adult development. DRD4 genotypes were available for 839 participants. Risk attributable to the combined effects of 7R+ genotype and insecure attachments was evaluated within a sufficient causes framework under the assumptions of additive interaction using a two-by-four table format with a common reference group. 7R+ alleles were associated with higher tobacco, cannabis and alcohol use (binging). Insecure attachments were associated with higher tobacco and cannabis use but lower alcohol use. For tobacco, there was evidence of interaction for anxious but not avoidant attachments. For cannabis, there was evidence of interaction for both anxious and avoidant attachments, although the interaction for anxious attachments was more substantial. There is no evidence of interaction for binge drinking. Results are consistent with a generic reward deficit hypothesis of drug addiction for which the 7R+ disposition may play a role. Interaction between 7R+ alleles and attachment insecurity may intensify risk for problematic tobacco and cannabis use.
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Affiliation(s)
- Craig A Olsson
- Department of Psychology, Deakin University, Australia Murdoch Children's Research Institute, Royal Children's Hospital, Australia.
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Erickson JA, Cho MK. Interest, rationale, and potential clinical applications of genetic testing for mood disorders: a survey of stakeholders. J Affect Disord 2013; 145:240-5. [PMID: 23021819 PMCID: PMC3612530 DOI: 10.1016/j.jad.2012.05.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 05/05/2012] [Indexed: 12/31/2022]
Affiliation(s)
- Jessica A Erickson
- Stanford Center for Biomedical Ethics Center for Integration of Research on Genetics and Ethics, CA 94305, USA.
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Bunnik EM, Schermer MHN, JW Janssens AC. The role of disease characteristics in the ethical debate on personal genome testing. BMC Med Genomics 2012; 5:4. [PMID: 22260407 PMCID: PMC3293088 DOI: 10.1186/1755-8794-5-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 01/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Companies are currently marketing personal genome tests directly-to-consumer that provide genetic susceptibility testing for a range of multifactorial diseases simultaneously. As these tests comprise multiple risk analyses for multiple diseases, they may be difficult to evaluate. Insight into morally relevant differences between diseases will assist researchers, healthcare professionals, policy-makers and other stakeholders in the ethical evaluation of personal genome tests. DISCUSSION In this paper, we identify and discuss four disease characteristics--severity, actionability, age of onset, and the somatic/psychiatric nature of disease--and show how these lead to specific ethical issues. By way of illustration, we apply this framework to genetic susceptibility testing for three diseases: type 2 diabetes, age-related macular degeneration and clinical depression. For these three diseases, we point out the ethical issues that are relevant to the question whether it is morally justifiable to offer genetic susceptibility testing to adults or to children or minors, and on what conditions. SUMMARY We conclude that the ethical evaluation of personal genome tests is challenging, for the ethical issues differ with the diseases tested for. An understanding of the ethical significance of disease characteristics will improve the ethical, legal and societal debate on personal genome testing.
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Affiliation(s)
- Eline M Bunnik
- Dept. of Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, dr. Molewaterplein 50, Rotterdam, 3015 GE, the Netherlands
| | - Maartje HN Schermer
- Dept. of Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, dr. Molewaterplein 50, Rotterdam, 3015 GE, the Netherlands
| | - A Cecile JW Janssens
- Dept. of Epidemiology, Erasmus University Medical Center, dr. Molewaterplein 50, Rotterdam, 3015 GE, the Netherlands
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9
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Erickson JA, Cho MK. Ethical Considerations and Risks in Psychiatric Genetics: Preliminary Findings of a Study on Psychiatric Genetic Researchers. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/21507716.2011.628958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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10
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Mitchell PB, Meiser B, Wilde A, Fullerton J, Donald J, Wilhelm K, Schofield PR. Predictive and diagnostic genetic testing in psychiatry. Clin Lab Med 2011; 30:829-46. [PMID: 20832655 DOI: 10.1016/j.cll.2010.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The recent advent of commercially available genetic tests for the diagnosis of several mental illnesses has led to intense controversy amongst the psychiatric research community. In this article the authors review these developments, and contrast these with the growing evidence from genomewide association studies that highly heritable psychiatric conditions such as schizophrenia are due to the contributions and interaction of multiple allelic variants, each of small effect size. There is also evidence for the contribution of some highly penetrant rare de novo copy number variants, though the lack of disease specificity for these is of concern. This article outlines the prerequisites for predictive and diagnostic genetic tests, such as clinical validity and utility, and reviews the opportunity that genetic tests for mental illnesses present. As the scientific discourse on genetic tests for complex disorders is not limited to psychiatry, the authors outline current thoughts on the significance of genome-wide association studies across health, and the phenomenon of direct-to-consumer tests in medicine. The attitudes and understanding of patients, families, and clinicians about the future (currently hypothetical) scenario of psychiatric genetic tests are discussed, as is the potential for such testing to increase, rather than diminish stigma. Finally, recommendations on the future development and availability of genetic tests in psychiatry are provided.
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Affiliation(s)
- Philip B Mitchell
- School of Psychiatry, Prince of Wales Hospital, University of New South Wales, Randwick, Sydney, NSW 2031, Australia.
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Rüsch N, Todd AR, Bodenhausen GV, Corrigan PW. Biogenetic models of psychopathology, implicit guilt, and mental illness stigma. Psychiatry Res 2010; 179:328-32. [PMID: 20493559 PMCID: PMC2928405 DOI: 10.1016/j.psychres.2009.09.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 07/25/2009] [Accepted: 09/22/2009] [Indexed: 11/26/2022]
Abstract
Whereas some research suggests that acknowledgment of the role of biogenetic factors in mental illness could reduce mental illness stigma by diminishing perceived responsibility, other research has cautioned that emphasizing biogenetic aspects of mental illness could produce the impression that mental illness is a stable, intrinsic aspect of a person ("genetic essentialism"), increasing the desire for social distance. We assessed genetic and neurobiological causal attributions about mental illness among 85 people with serious mental illness and 50 members of the public. The perceived responsibility of persons with mental illness for their condition, as well as fear and social distance, was assessed by self-report. Automatic associations between Mental Illness and Guilt and between Self and Guilt were measured by the Brief Implicit Association Test. Among the general public, endorsement of biogenetic models was associated with not only less perceived responsibility, but also greater social distance. Among people with mental illness, endorsement of genetic models had only negative correlates: greater explicit fear and stronger implicit self-guilt associations. Genetic models may have unexpected negative consequences for implicit self-concept and explicit attitudes of people with serious mental illness. An exclusive focus on genetic models may therefore be problematic for clinical practice and anti-stigma initiatives.
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Affiliation(s)
- Nicolas Rüsch
- Illinois Institute of Technology, Chicago, Illinois, USA.
| | - Andrew R. Todd
- Department of Psychology, Northwestern University, Evanston, Illinois
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13
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Abstract
The recent advent of commercially available genetic tests for the diagnosis of several mental illnesses has led to intense controversy amongst the psychiatric research community. In this article the authors review these developments, and contrast these with the growing evidence from genome-wide association studies that highly heritable psychiatric conditions such as schizophrenia are due to the contributions and interaction of multiple allelic variants, each of small effect size. There is also evidence for the contribution of some highly penetrant rare de novo copy number variants, though the lack of disease specificity for these is of concern. This article outlines the prerequisites for predictive and diagnostic genetic tests, such as clinical validity and utility, and reviews the opportunity that genetic tests for mental illnesses present. As the scientific discourse on genetic tests for complex disorders is not limited to psychiatry, the authors outline current thoughts on the significance of genome-wide association studies across health, and the phenomenon of direct-to-consumer tests in medicine. The attitudes and understanding of patients, families, and clinicians about the future (currently hypothetical) scenario of psychiatric genetic tests are discussed, as is the potential for such testing to increase, rather than diminish stigma. Finally, recommendations on the future development and availability of genetic tests in psychiatry are provided.
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Coors ME, Raymond KM. Substance use disorder genetic research: investigators and participants grapple with the ethical issues. Psychiatr Genet 2009; 19:83-90. [PMID: 19668113 PMCID: PMC2796541 DOI: 10.1097/ypg.0b013e328320800e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This qualitative research examined the ethical concerns regarding the psychosocial issues, research design and implementation, and application of psychiatric genetic research on substance use disorders (SUD) from multiple perspectives. METHODS A literature review of the bioethics literature related to psychiatric genetics and focus groups explored the ethical implications of SUD genetic research. Twenty-six National Institute on Drug Abuse funded principal investigators in the field of psychiatric genetic research, nine adolescent patients in residential SUD treatment, and 10 relatives of patients participated in focus groups (held separately). The focus groups were recorded, transcribed, and the content was analyzed. The themes that emerged from the literature and the focus group transcripts were organized by using NVIVO7, a software package designed to manage, analyze, and compare narrative data. RESULTS Investigators and the literature expressed similar concerns regarding the ethical concerns associated with psychiatric genetic research including violation of privacy, misunderstanding about psychiatric genetics, stigmatization, commercialization, discrimination, eugenics, consequences of research on illegal behavior, unforeseen consequences, altered notion of individual responsibility, and others. Patients and their relatives showed little familiarity with the ethical issues as identified by professionals and little concern regarding most of the potential risks. The exception was apprehension associated with potential criminal justice uses of stored genetic information, in particular enforced therapy and stigmatization, which elicited some concern from all perspectives. CONCLUSION The challenge for further research is to identify risks and benefits of SUD research that are germane in a behaviorally disinhibited population and devise effective tools to communicate information to participants through an improved informed consent process.
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Affiliation(s)
- Marilyn E. Coors
- Associate Professor of Bioethics, University of Colorado Denver Center for Bioethics and Humanities B137, 13120 East 19Avenue Aurora, CO 80045, Phone: 303-724-3993, Fax: 303-724-3997
| | - Kristen M. Raymond
- Senior Professional Research Assistant, University of Colorado Denver Department of Psychiatry F478, 12469 East 17Place Aurora, CO 80045, Phone: 303-761-8122
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Spriggs M. Is pragmatism just an apology for unrestrained science? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2008; 8:39-41. [PMID: 18576253 DOI: 10.1080/15265160802147199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Merle Spriggs
- Ethics Unit, Murdoch Childrens Research Institute, Melbourne, Australia.
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