1
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Iltis AS, Silverman HJ, Sade RM. Research ethics: Must subjects waive the right to withdraw from a xenotransplant clinical trial? J Thorac Cardiovasc Surg 2024; 167:1880-1884. [PMID: 37454725 DOI: 10.1016/j.jtcvs.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Ana S Iltis
- Department of Philosophy and Center for Bioethics, Health and Society, Wake Forest University, Winston-Salem, NC
| | - Henry J Silverman
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, Md
| | - Robert M Sade
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
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2
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Frenkel CH, Iltis AS, Casingal V, Atlas J. Considering Innovative Clinical Care for Organ Transplant Patients With Advanced Cutaneous Head and Neck Malignancies. Otolaryngol Head Neck Surg 2024; 170:630-633. [PMID: 37702195 DOI: 10.1002/ohn.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Catherine H Frenkel
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Ana S Iltis
- Department of Philosophy, Center for Bioethics, Health & Society Wake Forest University, Winston-Salem, North Carolina, USA
| | - Vincent Casingal
- Department of Transplant Surgery, Atrium Health, Charlotte, North Carolina, USA
| | - Jennifer Atlas
- Department of Hematology and Medical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
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3
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Venkatesh A, Iltis AS, Matthews KRW. Transparency in controversial research: A review of human embryo research publication ethical disclosure statements. Stem Cell Reports 2024; 19:28-36. [PMID: 38134926 PMCID: PMC10828690 DOI: 10.1016/j.stemcr.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
In 2021, the International Society for Stem Cell Research (ISSCR) released updated guidelines that included human embryo research guidance. Requiring ethics statements in publications using human embryos is one way to verify adherence to these guidelines. A review of top-tier biomedical journal requirements identified only one publisher that requires a human embryo statement. A review of articles using human embryos from top-tier biomedical journals found that all contain some form of ethics statement, but they differ in content and location. Requiring ethics statements with specific elements could improve transparency and adherence to research guidelines.
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Affiliation(s)
- Akshaya Venkatesh
- Baker Institute of Public Policy, Rice University, Houston, TX 77005, USA
| | - Ana S Iltis
- Baker Institute of Public Policy, Rice University, Houston, TX 77005, USA; Department of Philosophy and Center for Bioethics, Health and Society, Wake Forest University, Winston-Salem, NC 27109, USA
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4
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Salter EK, Hester DM, Vinarcsik L, Matheny Antommaria AH, Bester J, Blustein J, Wright Clayton E, Diekema DS, Iltis AS, Kopelman LM, Malone JR, Mercurio MR, Navin MC, Paquette ET, Pope TM, Rhodes R, Ross LF. Pediatric Decision Making: Consensus Recommendations. Pediatrics 2023; 152:e2023061832. [PMID: 37555276 DOI: 10.1542/peds.2023-061832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 08/10/2023] Open
Abstract
Despite apparent disagreement in the scholarly literature on standards of pediatric decision making, a recognition that similar norms underpin many of the dominant frameworks motivated a June 2022 symposium "Best Interests and Beyond: Standards of Decision Making in Pediatrics" in St Louis, MO. Over the course of this 3-day symposium, 17 expert scholars (see author list) deliberated on the question "In the context of US pediatric care, what moral precepts ought to guide parents and clinicians in medical decision making for children?" The symposium and subsequent discussion generated 6 consensus recommendations for pediatric decision making, constructed with the primary goals of accessibility, teachability, and feasibility for practicing clinicians, parents, and legal guardians. In this article, we summarize these recommendations, including their justification, limitations, and remaining concerns.
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Affiliation(s)
| | - D Micah Hester
- University of Arkansas for Medical Sciences, College of Medicine, Department of Medical Humanities & Bioethics, Little Rock, Arkansas
- Arkansas Children's Hospital, Little Rock, Arkansas
| | | | - Armand H Matheny Antommaria
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Ellen Wright Clayton
- Vanderbilt University Medical Center & Vanderbilt University, Nashville, Tennessee
| | | | - Ana S Iltis
- Wake Forest University, Winston-Salem, North Carolina
| | - Loretta M Kopelman
- East Carolina University, Greenville, North Carolina
- Georgetown University, Washington, District of Columbia
| | | | | | - Mark C Navin
- Oakland University, Rochester, Michigan
- Corwell Health East, Southfield, Michigan
| | - Erin Talati Paquette
- Northwestern University, Chicago, Illinois
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | - Lainie F Ross
- University of Chicago, Chicago, Illinois
- University of Rochester, Rochester New York
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5
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Iltis AS, Koster G, Reeves E, Matthews KRW. Ethical, legal, regulatory, and policy issues concerning embryoids: a systematic review of the literature. Stem Cell Res Ther 2023; 14:209. [PMID: 37605210 PMCID: PMC10441753 DOI: 10.1186/s13287-023-03448-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
Recent advances in methods to culture pluripotent stem cells to model human development have resulted in entities that increasingly have recapitulated advanced stages of early embryo development. These entities, referred to by numerous terms such as embryoids, are becoming more sophisticated and could resemble human embryos ever more closely as research progresses. This paper reports a systematic review of the ethical, legal, regulatory, and policy questions and concerns found in the literature concerning human embryoid research published from 2016 to 2022. We identified 56 papers that use 53 distinct names or terms to refer to embryoids and four broad categories of ethical, legal, regulatory, or policy considerations in the literature: research justifications/benefits, ethical significance or moral status, permissible use, and regulatory and oversight challenges. Analyzing the full range of issues is a critical step toward fostering more robust ethical, legal, and social implications research in this emerging area and toward developing appropriate oversight.
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Affiliation(s)
- Ana S Iltis
- Center for Bioethics, Health and Society and Department of Philosophy, Wake Forest University, Winston-Salem, NC, 27106, USA
| | - Grace Koster
- Center for Bioethics, Health and Society and Department of Philosophy, Wake Forest University, Winston-Salem, NC, 27106, USA
| | - Emily Reeves
- Center for Bioethics, Health and Society and Department of Philosophy, Wake Forest University, Winston-Salem, NC, 27106, USA
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6
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Iltis AS, Fortier R, Ontjes N, McCall WV. Ethics Considerations in Laws Restricting Incapacitated Patients' Access to ECT. J Am Acad Psychiatry Law 2023; 51:47-55. [PMID: 36646453 DOI: 10.29158/jaapl.220029-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Electroconvulsive therapy (ECT) is a safe and effective treatment used for numerous psychiatric conditions. While many patients for whom ECT is indicated are able to give voluntary informed consent, some lack decision-making capacity (DMC), at least temporarily. Case reports from numerous countries involving ECT for patients who lack DMC indicate overall positive outcomes and high patient satisfaction with results comparable with those of consenting patients; some patients regain DMC with ECT. Laws and regulations pertaining to ECT vary widely around the world and across the United States. Many United States jurisdictions over-regulate ECT relative to other interventions with comparable risks and potential benefits. While laws restricting whether and under what circumstances patients who lack DMC may receive ECT likely are aimed at protecting incapacitated persons, such laws sometimes undermine important ethics obligations and should be re-evaluated.
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Affiliation(s)
- Ana S Iltis
- Dr. Iltis is Professor of Philosophy, Carlson Professor of University Studies, and Director, Center for Bioethics, Health and Society; Ms. Fortier is an undergraduate student; and Mr. Ontjes is a graduate student, Wake Forest University, Winston-Salem, NC. Dr. McCall is Department Chair, Case Distinguished University Chairman, Department of Psychiatry and Health Behavior, and Executive Vice Dean, Medical College of Georgia, Augusta University, Augusta, GA.
| | - Reese Fortier
- Dr. Iltis is Professor of Philosophy, Carlson Professor of University Studies, and Director, Center for Bioethics, Health and Society; Ms. Fortier is an undergraduate student; and Mr. Ontjes is a graduate student, Wake Forest University, Winston-Salem, NC. Dr. McCall is Department Chair, Case Distinguished University Chairman, Department of Psychiatry and Health Behavior, and Executive Vice Dean, Medical College of Georgia, Augusta University, Augusta, GA
| | - Noah Ontjes
- Dr. Iltis is Professor of Philosophy, Carlson Professor of University Studies, and Director, Center for Bioethics, Health and Society; Ms. Fortier is an undergraduate student; and Mr. Ontjes is a graduate student, Wake Forest University, Winston-Salem, NC. Dr. McCall is Department Chair, Case Distinguished University Chairman, Department of Psychiatry and Health Behavior, and Executive Vice Dean, Medical College of Georgia, Augusta University, Augusta, GA
| | - William V McCall
- Dr. Iltis is Professor of Philosophy, Carlson Professor of University Studies, and Director, Center for Bioethics, Health and Society; Ms. Fortier is an undergraduate student; and Mr. Ontjes is a graduate student, Wake Forest University, Winston-Salem, NC. Dr. McCall is Department Chair, Case Distinguished University Chairman, Department of Psychiatry and Health Behavior, and Executive Vice Dean, Medical College of Georgia, Augusta University, Augusta, GA
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7
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Sawinski D, Ralston SJ, Coscia L, Klein CL, Wang EY, Porret P, O'Neill K, Iltis AS. Counselling, Research Gaps, and Ethical Considerations Surrounding Pregnancy in Solid Organ Transplant Recipients. J Bioeth Inq 2023; 20:89-99. [PMID: 36472763 DOI: 10.1007/s11673-022-10219-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/09/2022] [Indexed: 05/04/2023]
Abstract
Survival after solid-organ transplantation has improved significantly, and many contemporary transplant recipients are of childbearing potential. There are limited data to guide decision-making surrounding pregnancy after transplantation, variations in clinical practice, and significant knowledge gaps, all of which raise significant ethical issues. Post-transplant pregnancy is associated with an increased risk of maternal and fetal complications. Shared decision-making is a central aspect of patient counselling but is complicated by significant knowledge gaps. Stakeholder interests can be in conflict; exploring these tensions can help patients to evaluate their options and inform their deliberations. We argue that uniform, evidence-based recommendations for pregnancy after solid organ transplantation are needed. Conducting research, including patient-engaged studies, in this area should be priority for the transplant community.
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Affiliation(s)
- Deirdre Sawinski
- Nephrology and Transplantation, Weill Cornell Medical College, New York, NY, USA.
| | - Steven J Ralston
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Lisa Coscia
- Gift of Life Institute, Transplant Pregnancy Registry (TPR) International, Philadelphia, PA, USA
| | - Christina L Klein
- Department of Transplantation, Piedmont Transplant Institute, Piedmont Atlanta Hospital, Atlanta, GA, USA
| | - Eileen Y Wang
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Paige Porret
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathleen O'Neill
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ana S Iltis
- Center for Bioethics, Health and Society, Wake Forest University, Winston-Salem, NC, USA
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8
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Iltis AS, Rolf L, Yaeger L, Goodman MS, DuBois JM. Attitudes and beliefs regarding race-targeted genetic testing of Black people: A systematic review. J Genet Couns 2023; 32:435-461. [PMID: 36644818 DOI: 10.1002/jgc4.1653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 01/17/2023]
Abstract
Geographical ancestry has been associated with an increased risk of various genetic conditions. Race and ethnicity often have been used as proxies for geographical ancestry. Despite numerous problems associated with the crude reliance on race and ethnicity as proxies for geographical ancestry, some genetic testing in the clinical, research, and employment settings has been and continues to be race- or ethnicity-based. Race-based or race-targeted genetic testing refers to genetic testing offered only or primarily to people of particular racial or ethnic groups because of presumed differences among groups. One current example is APOL1 testing of Black kidney donors. Race-based genetic testing raises numerous ethical and policy questions. Given the ongoing reliance on the Black race in genetic testing, it is important to understand the views of people who identify as Black or are identified as Black (including African American, Afro-Caribbean, and Hispanic Black) regarding race-based genetic testing that targets Black people because of their race. We conducted a systematic review of studies and reports of stakeholder-engaged projects that examined how people who identify as or are identified as Black perceive genetic testing that specifically presumes genetic differences exist among racial groups or uses race as a surrogate for ancestral genetic variation and targets Black people. Our review identified 14 studies that explicitly studied this question and another 13 that implicitly or tacitly studied this matter. We found four main factors that contribute to a positive attitude toward race-targeted genetic testing (facilitators) and eight main factors that are associated with concerns regarding race-targeted genetic testing (barriers). This review fills an important gap. These findings should inform future genetic research and the policies and practices developed in clinical, research, public health, or other settings regarding genetic testing.
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Affiliation(s)
| | - Liz Rolf
- Washington University in St. Louis School of Medicine
| | - Lauren Yaeger
- Washington University in St. Louis School of Medicine
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9
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2023; 13:vii-viii. [PMID: 38661973 DOI: 10.1353/nib.2023.a924174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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10
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2023; 13:vii-viii. [PMID: 38661947 DOI: 10.1353/nib.2023.a909655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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11
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2023; 13:vii-ix. [PMID: 38661730 DOI: 10.1353/nib.2023.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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12
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Iltis AS, Shok N. Co-editors of the special issue "East European post-communist legacy in medicine, health care, and bioethics". Monash Bioeth Rev 2022; 40:1-5. [PMID: 36585540 DOI: 10.1007/s40592-022-00173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Ana S Iltis
- Carlson Professor of University Studies, Professor, Department of Philosophy, Director, Center for Bioethics, Health and Society, Wake Forest University, Winston-Salem, USA
| | - Nataliya Shok
- Professor, Department of Social and Humanitarian Science, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
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13
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2022; 12:vii-viii. [PMID: 36373515 DOI: 10.1353/nib.2022.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Iltis AS. Earning Mistrust through Fake Compromises and Broken Promises. Hastings Cent Rep 2022; 52:3. [PMID: 35476361 DOI: 10.1002/hast.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recent developments in human embryo research generate warranted public mistrust in science and scientists' willingness to honor commitments and respect limits. Patients, research participants, and society as a whole are asked to trust physicians, scientists, and biomedical institutions. Consistently honoring the laws, regulations, policies, and guidelines that govern science and health care practice is essential for earning and maintaining trust. Removing long-held and widely adopted limits on human embryo research, especially without publicly renegotiating a limit originally adopted following significant public discussion, undermines confidence in the self-regulation of science and the reliability of scientists' statements.
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2022; 12:vii-ix. [PMID: 35912592 DOI: 10.1353/nib.2022.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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16
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2022; 12:vii-viii. [PMID: 38661807 DOI: 10.1353/nib.2022.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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17
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Nestor JG, Li AJ, King KL, Husain SA, McIntosh TJ, Sawinski D, Iltis AS, Goodman MS, Walsh HA, DuBois JM, Mohan S. Impact of education on APOL1 testing attitudes among prospective living kidney donors. Clin Transplant 2022; 36:e14516. [PMID: 34661305 PMCID: PMC9113661 DOI: 10.1111/ctr.14516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 12/22/2022]
Abstract
It is unknown how providing prospective living donors with information about APOL1, including the benefits and drawbacks of testing, influences their desire for testing. In this study, we surveyed 102 participants with self-reported African ancestry and positive family history of kidney disease, recruited from our nephrology waiting room. We assessed views on APOL1 testing before and after presentation of a set of potential benefits and drawbacks of testing and quantified the self-reported level of influence individual benefits and drawbacks had on participants' desire for testing in the proposed context of living donation. The majority of participants (92%) were aware of organ donation and more than half (56%) had considered living donation. And though we found no significant change in response following presentation of the potential benefits and the drawbacks of APOL1 testing by study end significance, across all participants, "becoming aware of the potential risk of kidney disease among your immediate family" was the benefit with the highest mean influence (3.3±1.4), while the drawback with the highest mean influence (2.9±1.5) was "some transplant centers may not allow you to donate to a loved one". This study provides insights into the priorities of prospective living donors and suggests concern for how the information affects family members may strongly influence desires for testing. It also highlights the need for greater community engagement to gain a deeper understanding of the priorities that influence decision making on APOL1 testing.
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Affiliation(s)
- Jordan G. Nestor
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York, USA
| | - Amber J. Li
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York, USA
| | - Kristen L. King
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - S. Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
| | - Tristan J. McIntosh
- Bioethics Research Center, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Deirdre Sawinski
- Department of Medicine, Renal Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ana S. Iltis
- Center for Bioethics Health and Society and Department of Philosophy, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Melody S. Goodman
- School of Global Public Health, New York University, New York, New York, USA
| | - Heidi A. Walsh
- Bioethics Research Center, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - James M. DuBois
- Bioethics Research Center, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
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18
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2021; 11:vii-viii. [PMID: 34840159 DOI: 10.1353/nib.2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Iltis AS, Connell A, Cooper L, Gee PO, Jefferson NM, Johnson HA, Kingston GM, Roberts GV, Scott N, Smith A, Waddy S, Woodard L, DuBois JM. Improving Kidney Disease Research in the Black Community: The Essential Role of Black Voices in the APOLLO Study. Am J Kidney Dis 2021; 79:750-753. [PMID: 34653538 DOI: 10.1053/j.ajkd.2021.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/07/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Ana S Iltis
- Center for Bioethics, Health and Society, Wake Forest University, Winston-Salem, NC, USA.
| | | | | | | | | | | | | | | | | | | | | | | | - James M DuBois
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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20
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Iltis AS, Mehta M, Sawinski D. Ignorance is Not Bliss: The Case for Comprehensive Reproductive Counseling for Women with Chronic Kidney Disease. HEC Forum 2021:10.1007/s10730-021-09463-7. [PMID: 34617168 DOI: 10.1007/s10730-021-09463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
The bioethics literature has paid little attention to matters of informed reproductive decision-making among women of childbearing age who have chronic kidney disease (CKD), including women who are on dialysis or women who have had a kidney transplant. Women with CKD receive inconsistent and, sometimes, inadequate reproductive counseling, particularly with respect to information about pursuing pregnancy. We identify four factors that might contribute to inadequate and inconsistent reproductive counseling. We argue that women with CKD should receive comprehensive reproductive counseling, including information about the possibility of pursuing pregnancy, and that more rigorous research on pregnancy in women with CKD, including women on dialysis or who have received a kidney transplant, is warranted to improve informed reproductive decision making in this population.
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Affiliation(s)
- Ana S Iltis
- Center for Bioethics, Health and Society, Wake Forest University, Winston-Salem, NC, USA.
| | - Maya Mehta
- Center for Bioethics, Health and Society, Wake Forest University, Winston-Salem, NC, USA
| | - Deirdre Sawinski
- Renal Electrolyte, and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Iltis AS, McMillan G. Research on COVID-19: Stories from IRB Members, Research Administrators & Investigators. Narrat Inq Bioeth 2021; 11:1-6. [PMID: 34334454 DOI: 10.1353/nib.2021.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This symposium is separated into two sections. The first includes twelve personal stories from IRB members, administrators, or staff about their experiences during the COVID-19 pandemic. The second section includes twelve personal stories from researchers. Six commentaries on these narratives are offered by experts in research ethics, regulatory oversite, IRB administration, the logistics of clinical research, and investigator responsibilities. These narratives and commentaries offer an inside look at how the COVID-19 pandemic affected the physical logistics of clinical research already underway, demanded immediate investment in scientific investigation of vaccines and treatments, and rerouted the usual decision pathways that guide ethical practice.
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Abstract
The researchers' stories collected here demonstrate how many ethical and practical challenges routinely associated with conducting human research were amplified during the COVID-19 pandemic. These challenges include designing studies to minimize risks and maximize potential benefits, working with institutional review boards (IRBs), recruiting and enrolling participants, obtaining valid informed consent, promoting data integrity, managing budget constraints, and finding time to fulfill research obligations along with other duties. By offering insights about not only the barriers and challenges researchers encountered but also the creative solutions they and their colleagues found to conduct research, this behind-the-scenes peek at researchers' experiences helps us to identify barriers and potential lasting improvements for human subjects research even in the best of times.
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2021; 11:vii-viii. [PMID: 34334444 DOI: 10.1353/nib.2021.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2021; 10:v-vi. [PMID: 33583838 DOI: 10.1353/nib.2020.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2021; 10:v-vi. [PMID: 33416557 DOI: 10.1353/nib.2020.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2021; 10:v-vii. [PMID: 33416530 DOI: 10.1353/nib.2020.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2021; 11:vii-ix. [PMID: 35370161 DOI: 10.1353/nib.2021.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Matthews KRW, Iltis AS, Marquez NG, Wagner DS, Robert JS, de Melo-Martín I, Bigg M, Franklin S, Holm S, Metzler I, Molè MA, Taupitz J, Testa G, Sugarman J. Rethinking Human Embryo Research Policies. Hastings Cent Rep 2021; 51:47-51. [PMID: 33630327 PMCID: PMC7986614 DOI: 10.1002/hast.1215] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
It now seems technically feasible to culture human embryos beyond the "fourteen-day limit," which has the potential to increase scientific understanding of human development and perhaps improve infertility treatments. The fourteen-day limit was adopted as a compromise but subsequently has been considered an ethical line. Does it remain relevant in light of technological advances permitting embryo maturation beyond it? Should it be changed and, if so, how and why? What justifications would be necessary to expand the limit, particularly given that doing so would violate some people's moral commitments regarding human embryos? Robust stakeholder engagement preceded adoption of the fourteen-day limit and should arguably be part of efforts to reassess it. Such engagement could also consider the need for enhanced oversight of human embryo research. In the meantime, developing and implementing reliable oversight systems should help foster high-quality research and public confidence in it.
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Abstract
In most, if not all, jurisdictions with active organ transplantation programs, there is a persistent desire to increase donation rates because the demand for transplantable organs exceeds the supply. China, in particular, faces an extraordinary gap between the number of organs donated by deceased donors and the number of people seeking one or more transplants. China might look to Western countries with higher donation rates to determine how best to introduce Western practices into the Chinese system. In attempting to increase its organ donation rate, China must not only ensure that its organ donation system reflects different Chinese cultural values, but also that it avoids the ethical problems of the United States and of other Western systems. This article examines four such problems. They concern the family, obtaining permission for organ donation, the definition and diagnosis of "brain death," and trust. Revisions to the Chinese system should involve a careful look to China and Chinese cultural resources rather than to Western models.
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Affiliation(s)
- Ana S Iltis
- Wake Forest College, Winston-Salem, North Carolina, USA
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Freedman BI, Moxey-Mims MM, Alexander AA, Astor BC, Birdwell KA, Bowden DW, Bowen G, Bromberg J, Craven TE, Dadhania DM, Divers J, Doshi MD, Eidbo E, Fornoni A, Gautreaux MD, Gbadegesin RA, Gee PO, Guerra G, Hsu CY, Iltis AS, Jefferson N, Julian BA, Klassen DK, Koty PP, Langefeld CD, Lentine KL, Ma L, Mannon RB, Menon MC, Mohan S, Moore JB, Murphy B, Newell KA, Odim J, Ortigosa-Goggins M, Palmer ND, Park M, Parsa A, Pastan SO, Poggio ED, Rajapakse N, Reeves-Daniel AM, Rosas SE, Russell LP, Sawinski D, Smith SC, Spainhour M, Stratta RJ, Weir MR, Reboussin DM, Kimmel PL, Brennan DC. APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO): Design and Rationale. Kidney Int Rep 2020; 5:278-288. [PMID: 32154449 PMCID: PMC7056919 DOI: 10.1016/j.ekir.2019.11.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Much of the higher risk for end-stage kidney disease (ESKD) in African American individuals relates to ancestry-specific variation in the apolipoprotein L1 gene (APOL1). Relative to kidneys from European American deceased-donors, kidneys from African American deceased-donors have shorter allograft survival and African American living-kidney donors more often develop ESKD. The National Institutes of Health (NIH)-sponsored APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO) is prospectively assessing kidney allograft survival from donors with recent African ancestry based on donor and recipient APOL1 genotypes. METHODS APOLLO will evaluate outcomes from 2614 deceased kidney donor-recipient pairs, as well as additional living-kidney donor-recipient pairs and unpaired deceased-donor kidneys. RESULTS The United Network for Organ Sharing (UNOS), Association of Organ Procurement Organizations, American Society of Transplantation, American Society for Histocompatibility and Immunogenetics, and nearly all U.S. kidney transplant programs, organ procurement organizations (OPOs), and histocompatibility laboratories are participating in this observational study. APOLLO employs a central institutional review board (cIRB) and maintains voluntary partnerships with OPOs and histocompatibility laboratories. A Community Advisory Council composed of African American individuals with a personal or family history of kidney disease has advised the NIH Project Office and Steering Committee since inception. UNOS is providing data for outcome analyses. CONCLUSION This article describes unique aspects of the protocol, design, and performance of APOLLO. Results will guide use of APOL1 genotypic data to improve the assessment of quality in deceased-donor kidneys and could increase numbers of transplanted kidneys, reduce rates of discard, and improve the safety of living-kidney donation.
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Affiliation(s)
- Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Marva M. Moxey-Mims
- Division of Nephrology, Children's National Health System, Washington, DC, USA
| | - Amir A. Alexander
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Brad C. Astor
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kelly A. Birdwell
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University, Nashville, Tennessee, USA
| | - Donald W. Bowden
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Jonathan Bromberg
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Microbiology and Immunology, Division of Transplantation, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Timothy E. Craven
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Darshana M. Dadhania
- Division of Nephrology, Weill Cornell Medicine, New York, New York, USA
- Department of Transplantation Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Jasmin Divers
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mona D. Doshi
- Division of Nephrology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Elling Eidbo
- Association of Organ Procurement Organizations, Vienna, Virginia, USA
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension, Peggy and Harold Katz Drug Discovery Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael D. Gautreaux
- Human Leukocyte Antigen/Immunogenetics and Immunodiagnostics Laboratories, Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rasheed A. Gbadegesin
- Department of Pediatrics, Division of Nephrology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Patrick O. Gee
- APOLLO Community Advisory Council, Cleveland Clinic, Cleveland, Ohio, USA
| | - Giselle Guerra
- Katz Family Division of Nephrology and Hypertension, Peggy and Harold Katz Drug Discovery Center, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chi-yuan Hsu
- Department of Medicine, Division of Nephrology, University of California, San Francisco, San Francisco, California, USA
| | - Ana S. Iltis
- Center for Bioethics, Health and Society, Department of Philosophy, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Nichole Jefferson
- APOLLO Steering Committee, APOLLO Community Advisory Council, Dallas, Texas, USA
| | - Bruce A. Julian
- Department of Medicine, Division of Nephrology, University of Alabama School of Medicine in Birmingham, Birmingham, Alabama, USA
| | - David K. Klassen
- United Network for Organ Sharing, Office of the Chief Medical Officer, Richmond, Virginia, USA
| | - Patrick P. Koty
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carl D. Langefeld
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Krista L. Lentine
- Department of Medicine, Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Lijun Ma
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Roslyn B. Mannon
- Department of Medicine, Division of Nephrology, University of Alabama School of Medicine in Birmingham, Birmingham, Alabama, USA
| | - Madhav C. Menon
- Department of Nephrology, Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - J. Brian Moore
- Institutional Review Board, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Barbara Murphy
- Department of Nephrology, Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kenneth A. Newell
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonah Odim
- Transplantation Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Mariella Ortigosa-Goggins
- Katz Family Division of Nephrology and Hypertension, Peggy and Harold Katz Drug Discovery Center, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicholette D. Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Meyeon Park
- Department of Medicine, Division of Nephrology, University of California, San Francisco, San Francisco, California, USA
| | - Afshin Parsa
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Stephen O. Pastan
- Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Emilio D. Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nishadi Rajapakse
- National Institutes of Health, National Institute on Minority Health and Health Disparities, Division of Scientific Programs, Bethesda, Maryland, USA
| | - Amber M. Reeves-Daniel
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sylvia E. Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts, USA
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Laurie P. Russell
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Deirdre Sawinski
- Renal Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - S. Carrie Smith
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mitzie Spainhour
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Robert J. Stratta
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Matthew R. Weir
- Department of Medicine, Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Paul L. Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Daniel C. Brennan
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Iltis AS, McCall WV, Deria R. Suicidality, Depression, and the FDA: Health Inequities and the Ethical Conduct of Research. J Clin Psychiatry 2020; 81. [PMID: 32023368 DOI: 10.4088/jcp.19m13050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Persons with mental health disorders, including suicidality, are underrepresented in clinical trials, undermining the generalizability of results and possibly contributing to health inequities. This report (1) documents the exclusion of persons with suicidality in trials used to secure US Food and Drug Administration (FDA) approval for antidepressants, (2) describes barriers to inclusion, and (3) identifies possible steps for overcoming barriers. METHODS Inclusion and exclusion criteria for efficacy trials for depression or major depressive disorder described on FDA labels for 14 antidepressants approved from 1991 through 2013 were studied by reading the FDA labels, publications described on labels, and ClinicalTrials.gov entries for registered trials. Labels for drugs approved in or before 1998 were obtained through a Freedom of Information Act request filed June 26, 2018. For drugs approved after 1998, labels are on the FDA website. Publications based on the trials described on FDA labels were identified through a PubMed search on October 23, 2018, using each drug name and trial or study as the keywords and setting no date limit. RESULTS For drugs approved from 1991 to 2000, of 36 publications identified, 26 did not mention suicidality, 7 excluded persons with suicidality but did not describe assessing suicidality with an instrument, 2 excluded persons with suicidality and described assessing suicidality using at least 1 instrument, and 1 included persons with suicidality. For drugs approved from 2000 through 2013, of 28 publications identified, 4 did not mention suicidality, 12 reported excluding persons with suicidality but did not describe assessing suicidality with an instrument, 12 excluded persons with suicidality and described assessing suicidality using at least one instrument, and none included persons with suicidality. More stringent criteria for assessing and excluding based on suicidality very likely were applied for drugs approved post-2000. CONCLUSIONS The exclusion of persons with suicidality from antidepressant trials is common, creating uncertainty about medication safety and efficacy in parts of the target population. Information about study populations can be beneficial for prescribing clinicians, but it is not always readily available.
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Affiliation(s)
- Ana S Iltis
- Center for Bioethics, Health and Society, Wake Forest University, 1834 Wake Forest Rd, Winston-Salem, NC 27106. .,Center for Bioethics, Health and Society and Department of Philosophy, Wake Forest University, Winston-Salem, North Carolina, USA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Riyan Deria
- Center for Bioethics, Health and Society, Wake Forest University, Winston-Salem, North Carolina, USA
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2020; 9:v-vi. [PMID: 31956107 DOI: 10.1353/nib.2019.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
| | - Ana S. Iltis
- Center for Bioethics, Health and Society, Wake, Forest University, Winston-Salem, NC, USA
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Mohan S, Iltis AS, Sawinski D, DuBois JM. APOL1 Genetic Testing in Living Kidney Transplant Donors. Am J Kidney Dis 2019; 74:538-543. [PMID: 30982552 DOI: 10.1053/j.ajkd.2019.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/02/2019] [Indexed: 12/29/2022]
Abstract
The presence of 2 apolipoprotein L1 gene (APOL1) risk variants is associated with increased risk for chronic kidney disease and end-stage kidney disease. Inferior allograft outcomes following transplantation with kidneys from donors with 2 risk variants have also been reported. These data, coupled with anecdotal case reports and a recent cohort study of living donors, raise important questions about the potential increased kidney disease risk for living donors with APOL1 risk variants and the need for testing as part of the standard living donor evaluation process. We identify a series of questions that are central to the development of clinical policy regarding APOL1 testing of potential living kidney donors given the current uncertainty over the clinical implications of having 2 risk variants. We explore the ethical challenges that arise when determining when and to whom APOL1 testing should be offered, what potential donors should be told about APOL1 testing, how test results should be used to determine suitability for donation, if and when recipients should have access to results, and how clinical policy regarding APOL1 testing should be established.
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Affiliation(s)
- Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Columbia University Renal Epidemiology (CURE) Group, New York, NY.
| | - Ana S Iltis
- Center for Bioethics Health and Society, Wake Forest University, Winston Salem, NC; Department of Philosophy, Wake Forest University, Winston Salem, NC
| | - Deirdre Sawinski
- Renal, Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - James M DuBois
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO
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Iltis AS. Living Organ Donation Near and at the End of Life: Drawing and Re-Drawing the Boundaries Around Permissible Practices in Organ Donation. J Law Med Ethics 2019; 47:123-125. [PMID: 30994068 DOI: 10.1177/1073110519840491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Ana S Iltis
- Ana S. Iltis, Ph.D., is the Carlson Professor of University Studies, Professor of Philosophy, and Director of the Center for Bioethics, Health and Society at Wake Forest University in Winston-Salem, North Carolina
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2019; 9:v-vi. [PMID: 31447430 DOI: 10.1353/nib.2019.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2019; 9:v-vi. [PMID: 31031273 DOI: 10.1353/nib.2019.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Dubois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2018; 8:v-vi. [PMID: 30220681 DOI: 10.1353/nib.2018.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2018; 8:v-vi. [PMID: 30595570 DOI: 10.1353/nib.2018.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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M DuBois J, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2018; 8:79-80. [PMID: 29657182 DOI: 10.1353/nib.2018.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2018; 8:v. [PMID: 29657162 DOI: 10.1353/nib.2018.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2017; 7:v. [PMID: 29249697 DOI: 10.1353/nib.2017.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
This symposium includes 12 personal narratives from individuals who have faced a cancer diagnosis-either their own or their child's-where the disease itself, or their treatment, threatened future fertility. Three additional stories are available in the online supplement. Three commentaries on these narratives are written by an expert in oncofertility, a healthcare ethicist, and a pediatrician completing a fellowship in hematology/oncology. The observations and insights these authors share underscore the importance of addressing fertility loss and preservation early in the cancer journey. These contributions will help clinicians better understand the significance of fertility issues for children and younger adults diagnosed with cancer. They also can contribute to policy discussions about the role of health insurance in meeting the needs of cancer patients. Patients and families reading these stories and commentaries will appreciate learning from the experiences of others.
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2017; 7:v-vi. [PMID: 28713127 DOI: 10.1353/nib.2017.0000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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DuBois JM, Iltis AS, Walsh HA. Editors' Note. Narrat Inq Bioeth 2017; 7:v. [PMID: 29056627 DOI: 10.1353/nib.2017.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Abstract
The nature, possibility, and implications of ethics expertise (or moral expertise) in general and of bioethics expertise in particular has been the focus of extensive debate for over thirty years. What is ethics expertise and what does it enable experts to do? Knowing what ethics expertise is can help answer another important question: What, if anything, makes a claim of expertise legitimate? In other words, how does someone earn the appellation "ethics expert?" There remains deep disagreement on whether ethics expertise is possible, and if so, what constitutes such expertise and what it entails and legitimates. Discussion of bioethics expertise has become particularly important given the growing presence of bioethicists in the clinical setting as well as efforts to professionalize bioethics through codes of ethics and certification (or quasi-certification) efforts. Unlike in the law or in engineering, where there may be a body of knowledge that professional organizations or others have articulated as important for education and training of experts, ethics expertise admits of no such body of knowledge or required experience. Nor is there an entity seen as having the authority to articulate the necessary scope of knowledge. Questions about whether there is such a body of knowledge for particular areas within bioethics have emerged and played a central role in professionalization efforts in recent years, especially in the area of clinical ethics.
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Affiliation(s)
- Ana S Iltis
- Wake Forest University, Winston-Salem, North Carolina, USA University of North Carolina, Charlotte, North Carolina, USA
| | - Lisa M Rasmussen
- Wake Forest University, Winston-Salem, North Carolina, USA University of North Carolina, Charlotte, North Carolina, USA
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Abstract
The language of ethics expertise has become particularly important in bioethics in light of efforts to establish the value of the clinical ethics consultation (CEC), to specify who is qualified to function as a clinical ethics consultant, and to characterize how one should evaluate whether or not a person is so qualified. Supporters and skeptics about the possibility of ethics expertise use the language of ethics expertise in ways that reflect competing views about what ethics expertise entails. We argue for clarity in understanding the nature of expertise and ethics expertise. To be an ethics expert, we argue, is to be an expert in knowing what ought to be done. Any attempt to articulate expertise with respect to knowing what ought to be done must include an account of ethics that specifies the nature of moral truth and the means by which we access this truth or a theoretical account of ethics such that expertise in another domain is linked to knowing or being better at judging what ought to be done and the standards by which this "knowing" or "being better at judging" is determined. We conclude with a discussion of the implications of our analysis for the literature on ethics expertise in CEC. We do think that there are clear domains in which a clinical ethics consultant might be expert but we are skeptical about the possibility that this includes ethics expertise. Clinical ethics consultants should not be referred to as ethics experts.
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Affiliation(s)
- Ana S Iltis
- Wake Forest University, Winston-Salem, North Carolina, USA The Ethox Center, University of Oxford, Oxford, UK
| | - Mark Sheehan
- Wake Forest University, Winston-Salem, North Carolina, USA The Ethox Center, University of Oxford, Oxford, UK
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Iltis AS. Prenatal screening and prenatal diagnosis: contemporary practices in light of the past. J Med Ethics 2016; 42:334-339. [PMID: 27161556 DOI: 10.1136/medethics-2016-103623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Abstract
The 20th century eugenics movement in the USA and contemporary practices involving prenatal screening (PNS), prenatal diagnosis (PND), abortion and preimplantation genetic diagnosis (PGD) share important morally relevant similarities. I summarise some features of the 20th century eugenics movement; describe the contemporary standard of care in the USA regarding PNS, PND, abortion and PGD; and demonstrate that the 'old eugenics' the contemporary standard of care share the underlying view that social resources should be invested to prevent the birth of people with certain characteristics. This comparison makes evident the difficulty of crafting moral arguments that treat some uses of PNS, PND, abortion and PGD as licit and others as illicit.
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