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Halley MC, Olson NW. Blurred Boundaries: Toward an Expanded Ethics of Research and Clinical Care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:5-9. [PMID: 38410998 DOI: 10.1080/15265161.2023.2224148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
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Ward CL, Shaw D, Anane-Sarpong E, Sankoh O, Tanner M, Elger B. The Ethics of Health Care Delivery in a Pediatric Malaria Vaccine Trial: The Perspectives of Stakeholders From Ghana and Tanzania. J Empir Res Hum Res Ethics 2017; 13:26-41. [PMID: 29179625 DOI: 10.1177/1556264617742236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores ethical issues raised in providing medical care to participants and communities of low-resource settings involved in a Phase II/III pediatric malaria vaccine trial (PMVT). We conducted 52 key informant interviews with major stakeholders of an international multi-center PMVT (GSK/PATH-MVI RTS,S) (NCT00866619) in Ghana and Tanzania. Based on their stakeholder experiences, the responses fell into three main themes: (a) undue inducement, (b) community disparities, and (c) broad therapeutic misconceptions. The study identified the critical ethical aspects, from the perspectives of stakeholders, of delivering health care during a PMVT. The study showed that integrating research into health care services needs to be addressed in a manner that upholds the favorable risk-benefit ratio of research and attends to the health needs of local populations. The implementation of research should aim to improve local standards of care through building a collaborative agenda with local institutions and systems of health.
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Luyckx VA, Biller-Andorno N, Saxena A, Tran NT. Health policy and systems research: towards a better understanding and review of ethical issues. BMJ Glob Health 2017; 2:e000314. [PMID: 29225934 PMCID: PMC5717951 DOI: 10.1136/bmjgh-2017-000314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/01/2017] [Accepted: 04/04/2017] [Indexed: 11/04/2022] Open
Abstract
Given the focus on health systems in the post-millennium development goal era and moving towards the sustainable development goals, there is a compelling need for a common framework for health policy and systems research ethics to guide researchers and facilitate review by research ethics committees. A consultation of global health policy and systems research and ethics experts was convened to identify ethical considerations relevant to health policy and systems research based on existing knowledge and to identify knowledge gaps through a scoping review and further expert deliberation. Health policy and systems research is highly complex and, in the absence of guidance documents, there is significant variability in ethics review. Although fundamental ethical principles pertain to both traditional clinical research and health policy and systems research, the application of these principles requires a comprehensive understanding of the nature of health policy and systems research with its distinct challenges. Such awareness must be raised among researchers and research ethics committees. Current research ethics committees lack familiarity with health policy and systems research and because health policy and systems research is conducted in real-world contexts, committees often have difficulties in determining whether a project is indeed research and/or requires ethical review. Given the strong current focus on health policy and systems research to rapidly improve health and health systems functioning globally, greater engagement and dialogue around the ethical concerns is required to optimise research review and research conduct in this rapidly evolving field.
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Affiliation(s)
- Valerie Ann Luyckx
- Institute of Biomedical Ethics and History of Medicine, Universität Zürich, Zürich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, Universität Zürich, Zürich, Switzerland
| | - Abha Saxena
- Global Health Ethics Unit, World Health Organization, Geneva, Switzerland
| | - Nhan T Tran
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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Pratt B, Paul A, Hyder AA, Ali J. Ethics of health policy and systems research: a scoping review of the literature. Health Policy Plan 2017; 32:890-910. [DOI: 10.1093/heapol/czx003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 11/12/2022] Open
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Gopichandran V, Luyckx VA, Biller-Andorno N, Fairchild A, Singh J, Tran N, Saxena A, Launois P, Reis A, Maher D, Vahedi M. Developing the ethics of implementation research in health. Implement Sci 2016; 11:161. [PMID: 27938400 PMCID: PMC5148832 DOI: 10.1186/s13012-016-0527-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/29/2016] [Indexed: 02/03/2023] Open
Abstract
Implementation research (IR) is growing in recognition as an important generator of practical knowledge that can be translated into health policy. With its aim to answer questions about how to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them, IR involves a range of particular ethical considerations that have not yet been comprehensively covered in international guidelines on health research ethics. The fundamental ethical principles governing clinical research apply equally in IR, but the application of these principles may differ depending on the IR question, context, and the nature of the proposed intervention. IR questions cover a broad range of topics that focus on improving health system functioning and improving equitable and just access to effective health care interventions. As such, IR designs are flexible and often innovative, and ethical principles cannot simply be extrapolated from their applications in clinical research. Meaningful engagement with all stakeholders including communities and research participants is a fundamental ethical requirement that cuts across all study phases of IR and links most ethical concerns. Careful modification of the informed consent process may be required in IR to permit study of a needed intervention. The risks associated with IR may be difficult to anticipate and may be very context-specific. The benefits of IR may not accrue to the same groups who participate in the research, therefore justifying the risks versus benefits of IR may be ethically challenging. The expectation that knowledge generated through IR should be rapidly translated into health policy and practice necessitates up-front commitments from decision-makers to sustainability and scalability of effective interventions. Greater awareness of the particular ethical implications of the features of IR is urgently needed to facilitate optimal ethical conduct of IR and uniform ethical review.
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Affiliation(s)
- Vijayaprasad Gopichandran
- Department of Community Medicine, ESIC Medical College and Postgraduate Institute of Medical Sciences and Research, KK Nagar, Chennai, 600078, India.
| | - Valerie A Luyckx
- Institute of Biomedical Ethics and History of Medicine, Center for Medical Humanities, University of Zurich, Winterthurerstrasse 30, CH-8006, Zurich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, Center for Medical Humanities, University of Zurich, Winterthurerstrasse 30, CH-8006, Zurich, Switzerland
| | - Amy Fairchild
- Associate Dean of Academic Affairs, Texas A & M School of Public Health, College Station, Texas, USA
| | - Jerome Singh
- University of KwaZulu-Natal, Nelson Mandela School of Medicine, 719 Umbilo Road, Durban, 4001, South Africa
| | - Nhan Tran
- Alliance for Health Systems and Policy Research, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Abha Saxena
- Global Health Ethics Unit, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Pascal Launois
- Special Programme for Research and Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
| | - Andreas Reis
- Global Health Ethics Unit, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Dermot Maher
- Special Programme for Research and Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
| | - Mahnaz Vahedi
- Special Programme for Research and Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
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Jacobson N, Krupp A, Bowers BJ. Planning for Ancillary Care Provision: Lessons From the Developing World. J Empir Res Hum Res Ethics 2016; 11:129-34. [PMID: 26994734 PMCID: PMC4917407 DOI: 10.1177/1556264616637961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As part of a study designed to assess a new strategy for increasing health research participation by members of underrepresented populations in the United States, we explored expectations about volunteering for research among people from lower income and largely minority communities in Madison, Wisconsin. Members of these communities often saw research participation as a means to access health care that might otherwise be unavailable to them. In light of persistent structural barriers to access, and the resulting health disparities, we argue that one cannot assume the existence of a "fair exchange" in which a community is likely to benefit from the results of research conducted with members of that community. We use ethical analysis and empirical research conducted in the developing world to explore how investigators in the United States might think about their obligations to provide ancillary care.
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Hyder AA, Rattani A. Changing the discourse on health systems research: response to open peer commentaries on "ethical review of health systems research in low- and middle-income countries: a conceptual exploration". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:W1-W2. [PMID: 24521342 DOI: 10.1080/15265161.2014.881212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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