1
|
Earp BD, Porsdam Mann S, Allen J, Salloch S, Suren V, Jongsma K, Braun M, Wilkinson D, Sinnott-Armstrong W, Rid A, Wendler D, Savulescu J. A Personalized Patient Preference Predictor for Substituted Judgments in Healthcare: Technically Feasible and Ethically Desirable. Am J Bioeth 2024:1-14. [PMID: 38226965 DOI: 10.1080/15265161.2023.2296402] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient's (former) autonomy since it draws on the 'wrong' kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently 'fine-tuned' on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient's preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient's own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies.
Collapse
Affiliation(s)
- Brian D Earp
- University of Oxford
- National University of Singapore
- Yale University and The Hastings Center
| | | | | | | | | | - Karin Jongsma
- Julius Center of the University Medical Center Utrecht
| | | | - Dominic Wilkinson
- University of Oxford
- National University of Singapore
- John Radcliffe Hospital
- Murdoch Children's Research Institute
| | | | | | | | | |
Collapse
|
2
|
Dubé K, Morton T, Fox L, Dee L, Palm D, Villa TJ, Freshwater W, Taylor J, Graham G, Carter WB, Sauceda JA, Peluso MJ, Rid A. A partner protection package for HIV cure-related trials involving analytical treatment interruptions. Lancet Infect Dis 2023; 23:e418-e430. [PMID: 37295453 PMCID: PMC10543569 DOI: 10.1016/s1473-3099(23)00267-0] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 06/12/2023]
Abstract
Analytical treatment interruptions (ATIs) have become a key methodological approach to evaluate the effects of experimental HIV cure-related research interventions. During ATIs, sex partners of trial participants might be at risk of acquiring HIV. This risk raises both ethical and feasibility concerns about ATI trials. We propose a partner protection package (P3) approach to address these concerns. A P3 approach would provide guidance to investigators, sponsors, and those who are designing and implementing context-specific partner protections in HIV cure-related trials involving ATIs. The approach would also help assure institutional review boards, trial participants, and communities that ATI trials with a P3 would provide appropriate partner protections. We offer a prototype P3 framework that delineates three basic considerations for protecting participants' sex partners during ATI trials: (1) ensuring the scientific and social value of the ATI and the trial, (2) reducing the likelihood of unintended HIV transmission, and (3) ensuring prompt management of any acquired HIV infection. We outline possible ways of implementing these basic considerations.
Collapse
Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA; University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Tia Morton
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Lawrence Fox
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Lynda Dee
- Delaney AIDS Research Enterprise Community Engagement and Community Advisory Board University of California San Francisco, Department of Medicine, HIV, ID and Global Medicine, San Francisco, CA, USA; AIDS Action Baltimore, Baltimore, MD, USA
| | - David Palm
- AIDS Clinical Trials Group Global Community Advisory Board, Chapel Hill, NC, USA; Institute of Global Health and Infectious Diseases Clinical Trials Unit, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas J Villa
- HIV Obstruction by Programmed Epigenetics Delaney Collaboratory Community Advisory Board, Gladstone Institutes, San Francisco, CA, USA; National HIV & Aging Advocacy Network, National Minority AIDS Council, Washington, DC, USA; Reversing Immune Dysfunction HIV Delaney Collaboratory Community Advisory Board, Scripps Research, La Jolla, CA, USA; Rockville, MD, USA
| | | | - Jeff Taylor
- Delaney AIDS Research Enterprise Community Engagement and Community Advisory Board University of California San Francisco, Department of Medicine, HIV, ID and Global Medicine, San Francisco, CA, USA; Reversing Immune Dysfunction HIV Delaney Collaboratory Community Advisory Board, Scripps Research, La Jolla, CA, USA; Palm Springs, CA, USA; HIV + Aging Research Project, Palm Springs, CA, USA
| | | | - William B Carter
- Baltimore, MD, USA; BEAT-HIV Collaboratory Delaney Community Advisory Board, Wistar Institute, Philadelphia, PA, USA
| | - John A Sauceda
- Center for AIDS Prevention Studies, Division of Prevention Sciences, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Michael J Peluso
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Annette Rid
- Department of Bioethics, NIH Clinical Center, Bethesda, MD, USA
| |
Collapse
|
3
|
Charlton V, DiStefano M, Mitchell P, Morrell L, Rand L, Badano G, Baker R, Calnan M, Chalkidou K, Culyer A, Howdon D, Hughes D, Lomas J, Max C, McCabe C, O'Mahony JF, Paulden M, Pemberton-Whiteley Z, Rid A, Scuffham P, Sculpher M, Shah K, Weale A, Wester G. We need to talk about values: a proposed framework for the articulation of normative reasoning in health technology assessment. Health Econ Policy Law 2023:1-21. [PMID: 37752732 DOI: 10.1017/s1744133123000038] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
It is acknowledged that health technology assessment (HTA) is an inherently value-based activity that makes use of normative reasoning alongside empirical evidence. But the language used to conceptualise and articulate HTA's normative aspects is demonstrably unnuanced, imprecise, and inconsistently employed, undermining transparency and preventing proper scrutiny of the rationales on which decisions are based. This paper - developed through a cross-disciplinary collaboration of 24 researchers with expertise in healthcare priority-setting - seeks to address this problem by offering a clear definition of key terms and distinguishing between the types of normative commitment invoked during HTA, thus providing a novel conceptual framework for the articulation of reasoning. Through application to a hypothetical case, it is illustrated how this framework can operate as a practical tool through which HTA practitioners and policymakers can enhance the transparency and coherence of their decision-making, while enabling others to hold them more easily to account. The framework is offered as a starting point for further discussion amongst those with a desire to enhance the legitimacy and fairness of HTA by facilitating practical public reasoning, in which decisions are made on behalf of the public, in public view, through a chain of reasoning that withstands ethical scrutiny.
Collapse
Affiliation(s)
- Victoria Charlton
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Michael DiStefano
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Polly Mitchell
- School of Education, Communication and Society, King's College London, London, UK
| | - Liz Morrell
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Leah Rand
- Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Center for Bioethics, Harvard Medical School, Boston, MA, USA
| | | | - Rachel Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Michael Calnan
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | | | - Anthony Culyer
- Centre for Health Economics, University of York, York, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - James Lomas
- Centre for Health Economics, University of York, York, UK
| | | | - Christopher McCabe
- Centre for Public Health and Queens Management School, Queens University Belfast, Belfast, UK
| | - James F O'Mahony
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Mike Paulden
- School of Public Health, University of Alberta, Edmonton, Canada
| | | | - Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Paul Scuffham
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Koonal Shah
- Science Policy and Research Programme, National Institute for Health and Care Excellence, London, UK
| | - Albert Weale
- School of Public Policy, University College London, London, UK
| | | |
Collapse
|
4
|
Rid A, Feld JJ, Liang TJ, Weijer C. Ethics of Controlled Human Infection Studies With Hepatitis C Virus. Clin Infect Dis 2023; 77:S216-S223. [PMID: 37579202 PMCID: PMC10425137 DOI: 10.1093/cid/ciad382] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Global elimination of hepatitis C virus (HCV) will be difficult to attain without an effective HCV vaccine. Controlled human infection (CHI) studies with HCV were not considered until recently, when highly effective treatment became available. However, now that successful treatment of a deliberate HCV infection is feasible, it is imperative to evaluate the ethics of establishing a program of HCV CHI research. Here, we evaluate the ethics of studies to develop an HCV CHI model in light of 10 ethical considerations: sufficient social value, reasonable risk-benefit profile, suitable site selection, fair participant selection, robust informed consent, proportionate compensation or payment, context-specific stakeholder engagement, fair and open collaboration, independent review and oversight, and integrated ethics research. We conclude that it can be ethically acceptable to develop an HCV CHI model. Indeed, when done appropriately, developing a model should be a priority on the path toward global elimination of HCV.
Collapse
Affiliation(s)
- Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - T Jake Liang
- Liver Diseases Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Charles Weijer
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
- Department of Philosophy, Western University, London, Ontario, Canada
| |
Collapse
|
5
|
Affiliation(s)
- Emily E Ricotta
- Epidemiology and Data Management Unit, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, MD, USA.
| | - Annette Rid
- Department of Bioethics, Clinical Center, NIH, Bethesda, MD, USA
| | - I Glenn Cohen
- Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics, Harvard Law School, Cambridge, MA, USA
| | - Nicholas G Evans
- Department of Philosophy, University of Massachusetts Lowell, Lowell, MA, USA
| |
Collapse
|
6
|
Sugarman J, Wenner DM, Rid A, Henry LM, Luna F, Klitzman R, MacQueen KM, Rennie S, Singh JA, Gostin LO. Ethical research when abortion access is legally restricted. Science 2023; 380:1224-1226. [PMID: 37347876 PMCID: PMC10835672 DOI: 10.1126/science.adh3104] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Risks and benefits of some clinical research may be altered.
Collapse
Affiliation(s)
- Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle M Wenner
- Department of Philosophy and Center for Ethics and Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Leslie Meltzer Henry
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- University of Maryland Carey School of Law, Baltimore, MD, USA
| | - Florencia Luna
- Latin American School of Social Sciences (FLACSO) Bioethics Program, Institute for Social Research of Latin America (IICSAL), Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Robert Klitzman
- Vagelos College of Physicians and Surgeons and Joseph Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kathleen M MacQueen
- FHI 360, Durham, NC, USA
- UNC Center for AIDS Research, Chapel Hill, NC, USA
- Gillings School of Global Public Health and School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Stuart Rennie
- UNC Center for Bioethics, University of North Carolina, Chapel Hill, NC, USA
| | - Jerome Amir Singh
- School of Law, Howard College, University of KwaZulu-Natal, Durban, South Africa
- University of Toronto, Toronto, Canada
| | - Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| |
Collapse
|
7
|
Eckstein L, Rid A, Kamuya D, Shah SK. The Essential Role of Data and Safety Monitoring Boards (DSMBs) in Ensuring the Ethics of Global Vaccine Trials to Address Coronavirus Disease 2019 (COVID-19O). Clin Infect Dis 2021; 73:2126-2130. [PMID: 33758912 PMCID: PMC8083612 DOI: 10.1093/cid/ciab239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccines are being developed and implemented with unprecedented speed. Accordingly, trials considered ethical at their inception may quickly become concerning. We provide recommendations for Data and Safety Monitoring Boards (DSMBs) on monitoring the ethical acceptability of COVID-19 vaccine trials, focusing on placebo-controlled trials in low- and middle-income countries.
Collapse
Affiliation(s)
- Lisa Eckstein
- School of Law, University of Tasmania, Hobart, Australia
| | - Annette Rid
- Clinical Center Department of Bioethics & Division of AIDS, National Institutes of Health, Bethesda, MarylandUSA
| | - Dorcas Kamuya
- Health Systems and Research Ethics (HSRE) Department, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Seema K Shah
- Department of Pediatrics, Chicago, IllinoisUSA
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation (SCHORE) Center; Stanley Manne Children’s Research Institute; Lurie Children’s Hospital, Chicago, IllinoisUSA
| |
Collapse
|
8
|
Lyerly AD, Beigi R, Bekker L, Chi BH, Cohn SE, Diallo DD, Eron J, Faden R, Jaffe E, Kashuba A, Kasule M, Krubiner C, Little M, Mfustso‐Bengo J, Mofenson L, Mwapasa V, Mworeko L, Myer L, Penazzato M, Rid A, Shapiro R, Singh JA, Sullivan K, Vicari M, Wambui J, White A, Wickremsinhe M, Wolf L. Ending the evidence gap for pregnancy, HIV and co-infections: ethics guidance from the PHASES project. J Int AIDS Soc 2021; 24:e25846. [PMID: 34910846 PMCID: PMC8673925 DOI: 10.1002/jia2.25846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION While pregnant people have been an important focus for HIV research, critical evidence gaps remain regarding prevention, co-infection, and safety and efficacy of new antiretroviral therapies in pregnancy. Such gaps can result in harm: without safety data, drugs used may carry unacceptable risks to the foetus or pregnant person; without pregnancy-specific dosing data, pregnant people face risks of both toxicity and undertreatment; and delays in gathering evidence can limit access to beneficial next-generation drugs. Despite recognition of the need, numerous barriers and ethical complexities have limited progress. We describe the process, ethical foundations, recommendations and applications of guidance for advancing responsible inclusion of pregnant people in HIV/co-infections research. DISCUSSION The 26-member international and interdisciplinary Pregnancy and HIV/AIDS: Seeking Equitable Study (PHASES) Working Group was convened to develop ethics-centred guidance for advancing timely, responsible HIV/co-infections research with pregnant people. Deliberations over 3 years drew on extensive qualitative research, stakeholder engagement, expert consultation and a series of workshops. The guidance, initially issued in July 2020, highlights conceptual shifts needed in framing research with pregnant people, and articulates three ethical foundations to ground recommendations: equitable protection from drug-related risks, timely access to biomedical advances and equitable respect for pregnant people's health interests. The guidance advances 12 specific recommendations, actionable within the current regulatory environment, addressing multiple stakeholders across drug development and post-approval research, and organized around four themes: building capacity, supporting inclusion, achieving priority research and ensuring respect. The recommendations describe strategies towards ethically redressing the evidence gap for pregnant people around HIV and co-infections. The guidance has informed key efforts of leading organizations working to advance needed research, and identifies further opportunities for impact by a range of stakeholder groups. CONCLUSIONS There are clear pathways towards ethical inclusion of pregnant people in the biomedical research agenda, and strong agreement across the HIV research community about the need for - and the promise of - advancing them. Those who fund, conduct, oversee and advocate for research can use the PHASES guidance to facilitate more, better and earlier evidence to optimize the health and wellbeing of pregnant people and their children.
Collapse
Affiliation(s)
- Anne Drapkin Lyerly
- Department of Social Medicine and Center for BioethicsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Richard Beigi
- Department of ObstetricsGynecology & Reproductive SciencesUPMC Magee‐Women's HospitalPittsburghPennsylvaniaUSA
| | - Linda‐Gail Bekker
- Desmond Tutu HIV Centre and Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Benjamin H. Chi
- Department of Obstetrics and GynecologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Susan E. Cohn
- Department of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | | | - Joseph Eron
- Department of Medicine and Center for AIDS ResearchUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Ruth Faden
- Johns Hopkins Berman Institute of BioethicsBaltimoreMarylandUSA
| | - Elana Jaffe
- Department of Social Medicine and Center for BioethicsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Angela Kashuba
- Eshelman School of Pharmacy and Department of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Mary Kasule
- Botswana‐Baylor Centre for Clinical ExcellenceGabaroneBotswana
| | | | - Maggie Little
- Kennedy Institute for Ethics and Department of PhilosophyGeorgetown UniversityWashingtonDCUSA
| | - Joseph Mfustso‐Bengo
- Center of Bioethics for Eastern & Southern Africa and Department of Health Systems and PolicyCollege of MedicineUniversity of MalawiZombaMalawi
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS FoundationWashingtonDCUSA
| | | | - Lillian Mworeko
- International Community of Women Living with HIV Eastern AfricaKampalaUganda
| | - Landon Myer
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | | | - Annette Rid
- Department of BioethicsThe Clinical CenterNational Institutes of HealthBethesdaMarylandUSA
| | - Roger Shapiro
- Department of Immunology and Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Jerome Amir Singh
- Howard College School of LawUniversity of KwaZulu‐NatalKwaZulu‐NatalSouth Africa
- Dalla Lana School of Public Health Sciences, University of TorontoTorontoOntarioCanada
| | - Kristen Sullivan
- Department of Social Medicine and Center for BioethicsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | | | - Jacque Wambui
- National Empowerment Network of People Living with HIV and AIDS in Kenya (NEPHAK)African Communities Advisory Board (AfroCAB)LusakaZambia
| | - Amina White
- Department of Obstetrics and GynecologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Marisha Wickremsinhe
- Ethox Centre and Wellcome Centre for Ethics and HumanitiesUniversity of OxfordOxfordUK
| | - Leslie Wolf
- Center for LawHealth & Society and College of Law and School of Public HealthGeorgia State UniversityAtlantaGeorgiaUSA
| |
Collapse
|
9
|
Jardas EJ, Wesley R, Pavlick M, Wendler D, Rid A. Patients' Priorities for Surrogate Decision-Making: Possible Influence of Misinformed Beliefs. AJOB Empir Bioeth 2021; 13:137-151. [PMID: 34596487 DOI: 10.1080/23294515.2021.1983665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Many patients have three primary goals for how treatment decisions are made for them in the event of decisional incapacity. They want to be treated consistent with their preferences and values, they want their family to be involved in making decisions, and they want to minimize the stress on their family. The present paper investigates how patients' beliefs about surrogate decision-making influence which of these three goals they prioritize. Methods: Quantitative survey of 1,169 U.S. patients to assess their beliefs about surrogate decision-making, and how these beliefs influence patients' priorities for surrogate decision-making. Results: Most patients believed that families in general (68.8%) and their own family in particular (83.4%) frequently, almost always, or always know which treatments the patient would want in the event of incapacity. Patients with these beliefs were more likely to prioritize the goal of involving their family in treatment decision-making over the goal of minimizing family stress. Most patients (77.4%) also believed their family would experience significant stress from helping to make treatment decisions. However, patients' priorities were largely unchanged by this belief. Conclusions: Prior reports suggest that patients overestimate the extent to which their family knows which treatments they want in the event of decisional incapacity. The present analysis adds that these patients might be more likely to prioritize the goal of involving their family in treatment decision-making, even when this results in the family experiencing significant distress. This finding highlights that patients' misinformed beliefs about their family's knowledge might influence patients' priorities for surrogate decision-making, raising important questions for clinical practice, policy, and future research. Supplemental data for this article is available online at https://doi.org/10.1080/23294515.2021.1983665.
Collapse
Affiliation(s)
- E J Jardas
- Department of Bioethics, The Clinical Center, U.S. National Institutes of Health, Bethesda, Maryland, USA
| | - Robert Wesley
- Biostatistics and Clinical Epidemiology Service, The Clinical Center, U.S. National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Pavlick
- Department of Nursing, St. Elizabeths Hospital, Washington, District of Columbia, USA
| | - David Wendler
- Department of Bioethics, The Clinical Center, U.S. National Institutes of Health, Bethesda, Maryland, USA
| | - Annette Rid
- Department of Bioethics, The Clinical Center, U.S. National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
10
|
Iyer AA, Saade D, Bharucha-Goebel D, Foley AR, Averion G'M, Paredes E, Gray S, Bönnemann CG, Grady C, Hendriks S, Rid A. Ethical challenges for a new generation of early-phase pediatric gene therapy trials. Genet Med 2021; 23:2057-2066. [PMID: 34234300 DOI: 10.1038/s41436-021-01245-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 11/09/2022] Open
Abstract
After decades of setbacks, gene therapy (GT) is experiencing major breakthroughs. Five GTs have received US regulatory approval since 2017, and over 900 others are currently in development. Many of these GTs target rare pediatric diseases that are severely life-limiting, given a lack of effective treatments. As these GTs enter early-phase clinical trials, specific ethical challenges remain unresolved in three domains: evaluating risks and potential benefits, selecting participants fairly, and engaging with patient communities. Drawing on our experience as clinical investigators, basic scientists, and bioethicists involved in a first-in-human GT trial for an ultrarare pediatric disease, we analyze these ethical challenges and offer points to consider for future GT trials.
Collapse
Affiliation(s)
- Alexander A Iyer
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Dimah Saade
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Diana Bharucha-Goebel
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.,Children's National Hospital, Washington, DC, USA
| | - A Reghan Foley
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Gilberto 'Mike' Averion
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Eduardo Paredes
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Steven Gray
- University of Texas Southwestern Viral Vector Facility, Dallas, TX, USA
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Christine Grady
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Saskia Hendriks
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Annette Rid
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, MD, USA.
| |
Collapse
|
11
|
Rid A, Shah SK, Miller FG, Danis M, Nicolini M, Ochoa J, Taylor HA, Wendler DS, Grady C. Ethical trade-offs in vaccine development and distribution-Response to Gurwitz. Vaccine 2021; 39:1028-1029. [PMID: 33546811 DOI: 10.1016/j.vaccine.2021.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Annette Rid
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - Seema K Shah
- Lurie Children's Hospital, Northwestern University Department of Pediatrics, 225 E. Chicago Ave, Chicago, IL 60611, United States.
| | - Franklin G Miller
- Weill Cornell Medical College, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, United States.
| | - Marion Danis
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - Marie Nicolini
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - Jorge Ochoa
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - Holly A Taylor
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - David S Wendler
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - Christine Grady
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| |
Collapse
|
12
|
Affiliation(s)
- Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | |
Collapse
|
13
|
Affiliation(s)
- Camila Strassle
- From the Department of Bioethics, National Institutes of Health, Bethesda, MD
| | - E Jardas
- From the Department of Bioethics, National Institutes of Health, Bethesda, MD
| | - Jorge Ochoa
- From the Department of Bioethics, National Institutes of Health, Bethesda, MD
| | - Benjamin E Berkman
- From the Department of Bioethics, National Institutes of Health, Bethesda, MD
| | - Marion Danis
- From the Department of Bioethics, National Institutes of Health, Bethesda, MD
| | - Annette Rid
- From the Department of Bioethics, National Institutes of Health, Bethesda, MD
| | - Holly A Taylor
- From the Department of Bioethics, National Institutes of Health, Bethesda, MD
| |
Collapse
|
14
|
Vaswani V, Saxena A, Shah SK, Palacios R, Rid A. Informed consent for controlled human infection studies in low- and middle-income countries: Ethical challenges and proposed solutions. Bioethics 2020; 34:809-818. [PMID: 32779233 PMCID: PMC9627191 DOI: 10.1111/bioe.12795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
In controlled human infection studies (CHIs), participants are deliberately exposed to infectious agents in order to better understand the mechanism of infection or disease and test therapies or vaccines. While most CHIs have been conducted in high-income countries, CHIs have recently been expanding into low- and middle-income countries (LMICs). One potential ethical concern about this expansion is the challenge of obtaining the voluntary informed consent of participants, especially those who may not be literate or have limited education. In some CHIs in LMICs, researchers have attempted to address this potential concern by limiting access to literate or educated populations. In this paper, we argue that this practice is unjustified, as it does not increase the chances of obtaining valid informed consent and therefore unfairly excludes illiterate populations and populations with lower education. Instead, we recommend that investigators improve the informed consent process by drawing on existing data on obtaining informed consent in these populations and interventions aimed at improving their understanding. Based on a literature review, we provide concrete suggestions for how to follow this recommendation and ensure that populations with lower literacy or education are given a fair opportunity to protect their rights and interests in the informed consent process.
Collapse
Affiliation(s)
- Vina Vaswani
- Centre for Ethics, Yenepoya University, Managlore, India
| | - Abha Saxena
- The INCLEN Trust International, New Delhi, India
- Institut Éthique Histoire Humanités, University of Geneva, Geneva, Switzerland
| | - Seema K Shah
- Division of Academic General Pediatrics, Lurie Children's Hospital, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ricardo Palacios
- Clinical Trials and Pharmacovigilance Center, Instituto Butantan, São Paulo, Brazil
| | - Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of Health, Betherda, USA
| |
Collapse
|
15
|
Rid A, Roestenberg M. Judging the social value of controlled human infection studies. Bioethics 2020; 34:749-763. [PMID: 32844460 DOI: 10.1111/bioe.12794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 04/24/2020] [Accepted: 06/03/2020] [Indexed: 06/11/2023]
Abstract
In controlled human infection (CHI) studies, investigators deliberately infect healthy individuals with pathogens in order to study mechanisms of disease or obtain preliminary efficacy data on investigational vaccines and medicines. CHI studies offer a fast and cost-effective way of generating new scientific insights, prioritizing investigational products for clinical testing, and reducing the risk that large numbers of people are exposed to ineffective or harmful substances in research or in practice. Yet depending on the pathogen, CHI studies can involve significant risks or burdens for participants, pose risks to individuals or communities not involved in the research, and lead to public controversy. It is therefore essential to ensure that the risks of CHI studies are justified by their social value-that is, their potential to generate benefits for society-and that public trust can be maintained. In this paper, we aim to clarify how research sponsors, research ethics committees and other reviewers should judge the social value of CHI studies. We develop a list of relevant considerations for making social value judgments based on the standard view of social value. We then use this list to discuss the example of potentially conducting dengue virus CHI studies in endemic settings. We argue that dengue virus CHI studies in endemic settings would fall on the higher end of the spectrum of social value, mostly because of their potential to redirect all fields of future dengue research. Drawing on this discussion, we derive several general recommendations for how reviewers should judge the social value of CHI studies.
Collapse
Affiliation(s)
- Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Meta Roestenberg
- Department of Parasitology & Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
16
|
Affiliation(s)
- Seema K Shah
- Division of Academic General Pediatrics, Lurie Children's Hospital and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
17
|
van der Graaf R, Macklin R, Rid A, Bhan A, Gefenas E, Greco D, Haerry D, Hurst S, London AJ, Saracci R, Sprumont D, van Delden JJM. Integrating public health programs and research after the malaria vaccine implementation program (MVIP): Recommendations for next steps. Vaccine 2020; 38:6975-6978. [PMID: 32981780 DOI: 10.1016/j.vaccine.2020.08.077] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/21/2020] [Accepted: 08/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND In February 2020, international controversy arose about the ethical acceptability of the WHO Malaria Vaccine Implementation Program (MVIP). Whereas some have argued that this program must be seen as research that is not in line with international ethical standards, notably regarding informed consent and local ethical review, some WHO representatives consider the MVIP as a public health implementation program that need not adhere to these standards. METHODS We performed a case analysis in light of the 2016 CIOMS International Ethical Guidelines for Health-related Research involving Humans. FINDINGS We argue that the MVIP has a substantial research component, and that it is prudent to therefore apply ethical norms for research involving humans, such as the CIOMS guidelines. Accordingly, we agree that the ethical requirements of informed consent and independent ethical review have not been met. In addition, we are concerned that the study might not meet CIOMS's social value requirement. RECOMMENDATIONS We urge WHO to release more details about the process that led to the MVIP program and make the MVIP protocol publicly available. The full protocol should be assessed by the relevant ethics committees, new and already enrolled parents should be informed about the uncertainties under investigation and given a real opportunity to consent or refuse (continued) participation, communities should be engaged, and aspects of MVIP that require alteration in light of ethical review should be altered, if possible. Furthermore, in order to improve good ethical practices, it is necessary to engage in international debate regarding the integration of research and public health programs. Procedurally, vaccine implementation programs that combine both prevention and research should involve the wider international ethics community and ensure participation of the target populations in setting the proper conditions for launching such programs.
Collapse
Affiliation(s)
- Rieke van der Graaf
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, PO Box 85500, 3508 GA Utrecht, Netherlands(1).
| | - Ruth Macklin
- Distinguished University Professor Emerita, Albert Einstein College of Medicine, Bronx, NY, USA(2)
| | - Annette Rid
- National Institutes of Health, Department of Bioethics, The Clinical Center, USA(3)
| | - Anant Bhan
- Yenepoya (deemed to be University), India(4)
| | - Eugenijus Gefenas
- Centre for Health Ethics, Law and History, Institute of Health Sciences, Medical Faculty of Vilnius University, Lithuania(5)
| | - Dirceu Greco
- Professor Emeritus, Infectious Diseases and Bioethics, Federal University of Minas Gerais, Brazil(6)
| | - David Haerry
- European AIDS Treatment Group, Brussels, Belgium(7)
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Switzerland(8)
| | - Alex John London
- Carnegie Mellon University, Center for Ethics and Policy, Pittsburgh, PA, USA(9)
| | - Rodolfo Saracci
- Former President, International Epidemiological Association, Lyon, France(10)
| | - Dominique Sprumont
- Deputy Director, Institute of Health Law, University of Neuchâtel, Switzerland(11)
| | - Johannes J M van Delden
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Netherlands(12)
| |
Collapse
|
18
|
Grady C, Shah S, Miller F, Danis M, Nicolini M, Ochoa J, Taylor H, Wendler D, Rid A. So much at stake: Ethical tradeoffs in accelerating SARSCoV-2 vaccine development. Vaccine 2020; 38:6381-6387. [PMID: 32826103 PMCID: PMC7418641 DOI: 10.1016/j.vaccine.2020.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND A sense of urgency exists to develop vaccines against SARS CoV-2, responsible for numerous global cases and deaths, as well as widespread social and economic disruption. Multiple approaches have been proposed to speed up vaccine development, including accelerated randomized controlled trials (RCT), controlled human challenge trials (CHI), and wide distribution through an emergency use authorization after collecting initial data. There is a need to examine how best to accelerate vaccine development in the setting of a pandemic, without compromising ethical and scientific norms. METHODS Trade-offs in scientific and social value between generating reliable evidence about safety and efficacy while promoting rapid vaccine availability are examined along five ethically relevant dimensions: (1) confidence in and generalizability of data, (2) feasibility, (3) speed and cost, (4) participant risks, and (5) social risks. RESULTS Accelerated individually randomized RCTs permit expeditious evaluation of vaccine candidates using established methods, expertise, and infrastructure. RCTs are more likely than other approaches to be feasible, increase speed and reduce cost, and generate reliable data about safety and efficacy without significantly increasing risks to participants or undermining societal trust. CONCLUSION Ethical analysis suggests that accelerated RCTs are the best approach to accelerating vaccine development in a pandemic, and more likely than other approaches to enhance social value without compromising ethics or science. RCTs can expeditiously collect rigorous data about vaccine safety and efficacy. Innovative and flexible designs and implementation strategies to respond to shifting incidence and test vaccine candidates in parallel or sequentially would add value, as will coordinated data sharing across vaccine trials. CHI studies may be an important complementary strategy when more is known. Widely disseminating a vaccine candidate without efficacy data will not serve the public health nor achieve the goal of identifying safe and effective SARS Co-V-2 vaccines.
Collapse
Affiliation(s)
- Christine Grady
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - Seema Shah
- Lurie Children's Hospital, Northwestern University, Department of Pediatrics, 225 E. Chicago Ave, Chicago, IL 60611, United States.
| | - Franklin Miller
- Weill Cornell Medical College, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, United States.
| | - Marion Danis
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - Marie Nicolini
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - Jorge Ochoa
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - Holly Taylor
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - Dave Wendler
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| | - Annette Rid
- Department of Bioethics, National Institutes of Health Clinical Center, Building 10/1C118, NIH, Bethesda, MD 20892, United States.
| |
Collapse
|
19
|
Shah SK, Miller FG, Darton TC, Duenas D, Emerson C, Lynch HF, Jamrozik E, Jecker NS, Kamuya D, Kapulu M, Kimmelman J, MacKay D, Memoli MJ, Murphy SC, Palacios R, Richie TL, Roestenberg M, Saxena A, Saylor K, Selgelid MJ, Vaswani V, Rid A. Unnecessary hesitancy on human vaccine tests-Response. Science 2020; 369:151. [PMID: 32646992 DOI: 10.1126/science.abc9380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
20
|
Abstract
As hospitals have experienced a surge of Covid‐19 patients, investigators of Covid‐19 treatment trials face a difficult problem: when an institution has more eligible and interested patients than trial slots, who should be enrolled? Defining a clear strategy for selecting participants for “high‐demand” Covid‐19 treatment trials is important to avoid ad hoc and potentially biased decision‐making by local investigators, which could inadvertently compromise a trial's social value, participants’ interests, or fairness. In this article, we propose a set of ethical criteria for evaluating participant‐selection strategies for such trials. We argue that the pandemic context—in particular, great urgency to develop safe and effective treatments, uncertainty surrounding Covid‐19, and strain on the health care system that limits the time and effort available for trial enrollment—favors participant‐selection strategies that optimize the ease of enrollment and, ideally, social value. A lottery and, where possible, a weighted lottery have important advantages in these respects.
Collapse
Affiliation(s)
- Alexander A Iyer
- Fellow in the Department of Bioethics at the National Institutes of Health (NIH) Clinical Center
| | - Saskia Hendriks
- Bioethicist in the Department of Bioethics at the National Institutes of Health Clinical Center
| | - Annette Rid
- Bioethicist in the Department of Bioethics at the National Institutes of Health Clinical Center
| |
Collapse
|
21
|
Abstract
In this paper we describe the process and content of our ad hoc public health ethics consultation for a Bavarian health authority in relation to Covid-19.
Collapse
Affiliation(s)
- Verina Wild
- Institut für Ethik, Geschichte und Theorie der Medizin,
Ludwig-Maximilians-Universität München
| | - Alena Buyx
- Institut für Geschichte und Ethik der Medizin, Technische
Universität München
| | - Samia Hurst
- Institute For Ethics, History, and The Humanities, University of
Geneva, Switzerland
| | - Christian Munthe
- Department of philosophy, linguistics and theory of science and the
Centre for antibiotic resistance research (CARe), University of Gothenburg,
Gothenburg, Sweden
| | - Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of
Health, USA, Bethesda, United States
| | - Peter Schröder-Bäck
- Department of International Health, School for Public Health and
Primary Care (caphri), Maastricht University, Maastricht,
Netherlands
- Faculty of Human and Health Sciences, University of
Bremen
| | - Daniel Strech
- QUEST Center – Quality, Ethics, Open Science, Translation,
Berlin Institute of Health (BIH)
- Charité – Universitätsmedizin
Berlin
| | - Alison Thompson
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| |
Collapse
|
22
|
Shah SK, Miller FG, Darton TC, Duenas D, Emerson C, Lynch HF, Jamrozik E, Jecker NS, Kamuya D, Kapulu M, Kimmelman J, MacKay D, Memoli MJ, Murphy SC, Palacios R, Richie TL, Roestenberg M, Saxena A, Saylor K, Selgelid MJ, Vaswani V, Rid A. Ethics of controlled human infection to address COVID-19. Science 2020; 368:832-834. [PMID: 32381590 DOI: 10.1126/science.abc1076] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Seema K Shah
- Author affiliations are listed in the supplementary materials.
| | | | - Thomas C Darton
- Author affiliations are listed in the supplementary materials
| | - Devan Duenas
- Author affiliations are listed in the supplementary materials
| | - Claudia Emerson
- Author affiliations are listed in the supplementary materials
| | | | | | - Nancy S Jecker
- Author affiliations are listed in the supplementary materials
| | - Dorcas Kamuya
- Author affiliations are listed in the supplementary materials
| | - Melissa Kapulu
- Author affiliations are listed in the supplementary materials
| | | | - Douglas MacKay
- Author affiliations are listed in the supplementary materials
| | | | - Sean C Murphy
- Author affiliations are listed in the supplementary materials
| | | | - Thomas L Richie
- Author affiliations are listed in the supplementary materials
| | | | - Abha Saxena
- Author affiliations are listed in the supplementary materials
| | | | | | - Vina Vaswani
- Author affiliations are listed in the supplementary materials
| | - Annette Rid
- Author affiliations are listed in the supplementary materials
| |
Collapse
|
23
|
Aguilera B, DeGrazia D, Rid A. Regulating international clinical research: an ethical framework for policy-makers. BMJ Glob Health 2020; 5:e002287. [PMID: 32461225 PMCID: PMC7259867 DOI: 10.1136/bmjgh-2020-002287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/03/2022] Open
Abstract
The global distribution of clinical trials is shifting to low-income and middle-income countries (LMICs), and adequate regulations are essential for protecting the rights and interests of research participants in these countries. However, policy-makers in LMICs can face an ethical trade-off: stringent regulatory protections for participants can lead researchers or sponsors to conduct their research elsewhere, potentially depriving the local population of the opportunity to benefit from international clinical research. In this paper, we propose a three-step ethical framework that helps policy-makers to navigate this trade-off. We use a recent set of regulatory protections in Chile to illustrate the practical value of our proposed framework, providing original ethical analysis and previously unpublished data from Chile obtained through freedom of information requests.
Collapse
Affiliation(s)
- Bernardo Aguilera
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - David DeGrazia
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
- Department of Philosophy, George Washington University, Washington, DC, USA
| | - Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
24
|
Affiliation(s)
| | | | - Annette Rid
- National Institutes of Health Clinical Center
| |
Collapse
|
25
|
Abstract
On the occasion of the 40th anniversary of the Belmont Report-one of the foundational documents of modern research ethics-this article reviews the ethical debate about the social value of health-related research with human participants. It shows that the Belmont Report discusses the social value of research only cursorily, much like most of the research ethics literature until recently. The article then reviews the current debate and open questions about the social value of health-related research, organized around three questions: (1) is social value a necessary ethical requirement for health-related research with human participants? (2) if so, how should a social value requirement should be specified? and (3) how should such a requirement be implemented in practice?
Collapse
|
26
|
Rumbold B, Charlton V, Rid A, Mitchell P, Wilson J, Littlejohns P, Max C, Weale A. Affordability and Non-Perfectionism in Moral Action. Ethical Theory Moral Pract 2019; 22:973-991. [PMID: 31866757 PMCID: PMC6890613 DOI: 10.1007/s10677-019-10028-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2019] [Indexed: 06/10/2023]
Abstract
One rationale policy-makers sometimes give for declining to fund a service or intervention is on the grounds that it would be 'unaffordable', which is to say, that the total cost of providing the service or intervention for all eligible recipients would exceed the budget limit. But does the mere fact that a service or intervention is unaffordable present a reason not to fund it? Thus far, the philosophical literature has remained largely silent on this issue. However, in this article, we consider this kind of thinking in depth. Albeit with certain important caveats, we argue that the use of affordability criteria in matters of public financing commits what Parfit might have called a 'mistake in moral mathematics'. First, it fails to abide by what we term a principle of 'non-perfectionism' in moral action: the mere fact that it is practically impossible for you to do all the good that you have reason to do does not present a reason not to do whatever good you can do. And second, when used as a means of arbitrating between which services to fund, affordability criteria can lead to a kind of 'numerical discrimination'. Various attendant issues around fairness and lotteries are also discussed.
Collapse
Affiliation(s)
- Benedict Rumbold
- Department of Philosophy, University of Nottingham, Nottingham, UK
| | - Victoria Charlton
- Department of Global Health & Social Medicine, King’s College London, London, UK
| | - Annette Rid
- Department of Bioethics, The Clinical Center, U.S. National Institutes of Health, Bethesda, MD USA
| | - Polly Mitchell
- Department of Philosophy, University College London, London, UK
| | - James Wilson
- Department of Philosophy, University College London, London, UK
| | - Peter Littlejohns
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | | | - Albert Weale
- Department of Political Science, University College London, London, UK
| |
Collapse
|
27
|
Rid A, Littmann J, Buyx A. Evaluating the risks of public health programs: Rational antibiotic use and antimicrobial resistance. Bioethics 2019; 33:734-748. [PMID: 31423609 DOI: 10.1111/bioe.12653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/19/2018] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 06/10/2023]
Abstract
Existing ethical frameworks for public health provide insufficient guidance on how to evaluate the risks of public health programs that compromise the best clinical interests of present patients for the benefit of others. Given the relevant similarity of such programs to clinical research, we suggest that insights from the long-standing debate about acceptable risk in clinical research can helpfully inform and guide the evaluation of risks posed by public health programs that compromise patients' best clinical interests. We discuss how lessons learned regarding the ethics of risk in one context can be fruitfully transferred to the other, using the example of a so-called 'rational antibiotic use' guideline that limits antimicrobial prescribing in order to curb antimicrobial resistance.
Collapse
Affiliation(s)
- Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, Maryland, United States
| | - Jasper Littmann
- Norwegian Institute of Public Health, Centre for Antimicrobial Resistance, Oslo, Norway
| | - Alena Buyx
- Institute for History and Ethics of Medicine, Technical University Munich, Germany
| |
Collapse
|
28
|
Abstract
All healthcare systems operate with limited resources and therefore need to set priorities for allocating resources across a population. Trade-offs between maximising health and promoting health equity are inevitable in this process. In this paper, we use the UK's National Institute for Health and Care Excellence (NICE) as an example to examine how efforts to promote healthcare innovation in the priority-setting process can complicate these trade-offs. Drawing on NICE guidance, health technology assessment reports and relevant policy documents, we analyse under what conditions NICE recommends the National Health Service fund technologies of an "innovative nature", even when these technologies do not satisfy NICE's cost-effectiveness criteria. Our findings fail to assuage pre-existing concerns that NICE's approach to appraising innovative technologies curtails its goals to promote health and health equity. They also reveal a lack of transparency and accountability regarding NICE's treatment of innovative technologies, as well as raising additional concerns about equity. We conclude that further research needs to evaluate how NICE can promote health and health equity alongside healthcare innovation and draw some general lessons for healthcare priority-setting bodies like NICE.
Collapse
Affiliation(s)
- Victoria Charlton
- Department of Global Health & Social Medicine, King’s College London, 40 Aldwych, London, WC2B 4BG UK
| | - Annette Rid
- Department of Global Health & Social Medicine, King’s College London, 40 Aldwych, London, WC2B 4BG UK
- Department of Bioethics, The Clinical Center, U.S. National Institutes of Health, Bethesda, USA
| |
Collapse
|
29
|
Littlejohns P, Chalkidou K, Culyer AJ, Weale A, Rid A, Kieslich K, Coultas C, Max C, Manthorpe J, Rumbold B, Charlton V, Roberts H, Faden R, Wilson J, Krubiner C, Mitchell P, Wester G, Whitty JA, Knight S. National Institute for Health and Care Excellence, social values and healthcare priority setting. J R Soc Med 2019; 112:173-179. [PMID: 30939251 DOI: 10.1177/0141076819842846] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Peter Littlejohns
- 1 Professor of Public Health, Faculty of Life Sciences and Medicine, King's College London
| | - Kalipso Chalkidou
- 2 Professor of Practice in Global Health at Imperial College London and Director of Global Health Policy and a Senior Fellow at the Centre of Global Development
| | | | - Albert Weale
- 4 Emeritus Professor of Political Theory and Public Policy, University College London
| | - Annette Rid
- 5 Bioethicist, Department of Bioethics, The Clinical Centre, National Institutes of Health, USA
| | - Katharina Kieslich
- 6 Postdoctoral Researcher, Department of Political Science, University of Vienna, Austria
| | - Clare Coultas
- 7 Research Associate, Collaboration for Leadership in Applied Health Research and Care South London, King's College London
| | | | - Jill Manthorpe
- 9 Professor of Social Work and Director of the NIHR Health & Social Care Workforce Research Unit King's College London
| | - Benedict Rumbold
- 10 Assistant Professor in Philosophy, Department of Philosophy, University of Nottingham
| | - Victoria Charlton
- 11 Bioethicist, Department of Global Health & Social Medicine, King's College London
| | - Helen Roberts
- 12 Professor of Child Health Research, UCL Great Ormond Street Institute of Child Health
| | - Ruth Faden
- 13 Founder, Johns Hopkins Berman Institute of Bioethics, USA
| | - James Wilson
- 14 Senior Lecturer in Philosophy University College London
| | - Carleigh Krubiner
- 15 Policy Fellow, Centre for Global Development Faculty, Johns Hopkins Berman Institute of Bioethics
| | - Polly Mitchell
- 16 Research Associate, School of Education, Communication and Society, King's College London
| | - Gry Wester
- 17 Lecturer in Bioethics and Global Health Ethics, Department of Global Health & Social Medicine, King's College London
| | | | - Selena Knight
- 19 Academic Clinical Fellow in General Practice, King's College London
| |
Collapse
|
30
|
Abstract
Background To reduce the effect of antimicrobial resistance and to preserve antibiotic effectiveness, clinical guidelines and health policy documents call for the rational use of antibiotics, which aims to reduce unnecessary or minimally effective antibiotic use. Methods Through ethical analysis, we show that rational use programmes can lead to ethical conflicts, because they sometimes place patients at risk of harm-for example, a delayed switch to second-line antibiotics for community-acquired pneumonia can lead to substantial increases in mortality. Results Implementing the rational use of antibiotics can lead to conflicts between promoting patients' clinical interests and preserving antibiotic effectiveness for future use. The resulting ethical dilemma for clinicians, patients and policy makers has so far not been adequately addressed. Conclusions Existing guidance for acceptable risks in clinical research can help to define risk thresholds for the rational use of antibiotics. We develop an ethical framework that allows clinicians and policy-makers to evaluate policies for rational antibiotic use in six practical steps. This framework can help guide clinical practice and health policy.
Collapse
Affiliation(s)
| | - Annette Rid
- Department of Global Health and Social Medicine, King's College London, Strand, London, UK
| | - Alena Buyx
- Division of Bioethics, Institute of Experimental Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| |
Collapse
|
31
|
Abstract
In a Policy Forum, Marc Lipsitch and colleagues discuss trial design issues in infectious disease outbreaks.
Collapse
Affiliation(s)
- Rebecca Kahn
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Annette Rid
- Department of Global Health & Social Medicine, King’s College London, London, United Kingdom
| | - Peter G. Smith
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nir Eyal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
32
|
Ives J, Dunn M, Molewijk B, Schildmann J, Bærøe K, Frith L, Huxtable R, Landeweer E, Mertz M, Provoost V, Rid A, Salloch S, Sheehan M, Strech D, de Vries M, Widdershoven G. Standards of practice in empirical bioethics research: towards a consensus. BMC Med Ethics 2018; 19:68. [PMID: 29986689 PMCID: PMC6038185 DOI: 10.1186/s12910-018-0304-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 05/29/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This paper reports the process and outcome of a consensus finding project, which began with a meeting at the Brocher Foundation in May 2015. The project sought to generate and reach consensus on standards of practice for Empirical Bioethics research. The project involved 16 academics from 5 different European Countries, with a range of disciplinary backgrounds. METHODS The consensus process used a modified Delphi approach. RESULTS Consensus was reached on 15 standards of practice, organised into 6 domains of research practice (Aims, Questions, Integration, Conduct of Empirical Work, Conduct of Normative Work; Training & Expertise). CONCLUSIONS Through articulating these standards we outline a position that encourages responses, and through those responses we will be able to identify points of agreement and contestation that will drive the conversation forward. In that vein, we would encourage researchers, funders and journals to engage with what we have proposed, and respond to us, so that our community of practice of empirical bioethics research can develop and evolve further.
Collapse
Affiliation(s)
| | | | | | - Jan Schildmann
- Martin Luther University Halle-Wittenberg, Halle, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Rid A. The Next Wave in Health Care Priority Setting. Hastings Cent Rep 2018; 48:inside front cover. [DOI: 10.1002/hast.872] [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: 11/12/2022]
|
34
|
Rid A. Individual and public interests in clinical research during epidemics: a reply to Calain : In response to: Calain P. The Ebola clinical trials: a precedent for research ethics in disasters. J Med Ethics 2018; 44:11-12. [PMID: 28137997 DOI: 10.1136/medethics-2016-104120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/06/2017] [Indexed: 06/06/2023]
|
35
|
Affiliation(s)
- Spencer Phillips Hey
- Harvard Center for Bioethics, Boston, MA, USA
- Program on Regulation, Therapeutics, and Law, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alex John London
- Center for Ethics and Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Charles Weijer
- Departments of Philosophy and Medicine, University of Western Ontario, London, ON, Canada
| | - Annette Rid
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Franklin Miller
- Medical Ethics in Medicine, Weill Cornell Medical College, New York, USA
| |
Collapse
|
36
|
Rumbold B, Baker R, Ferraz O, Hawkes S, Krubiner C, Littlejohns P, Norheim OF, Pegram T, Rid A, Venkatapuram S, Voorhoeve A, Wang D, Weale A, Wilson J, Yamin AE, Hunt P. Universal health coverage, priority setting, and the human right to health. Lancet 2017; 390:712-714. [PMID: 28456508 PMCID: PMC6728156 DOI: 10.1016/s0140-6736(17)30931-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 12/09/2016] [Accepted: 01/17/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Benedict Rumbold
- Department of Philosophy, University College London, London, UK.
| | - Rachel Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Octavio Ferraz
- The Dickson Poon School of Law, Kings College London, London, UK
| | - Sarah Hawkes
- Institute for Global Health, University College London, London, UK
| | - Carleigh Krubiner
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, Kings College London, London, UK
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Thomas Pegram
- Department of Political Science, University College London, London, UK
| | - Annette Rid
- Department of Global Health and Social Medicine, Kings College London, London, UK
| | - Sridhar Venkatapuram
- Department of Global Health and Social Medicine, Kings College London, London, UK; Department of Philosophy, University of Johannesburg, Johannesburg, South Africa
| | - Alex Voorhoeve
- Department of Philosophy, Logic and Scientific Method, London School of Economics, London, UK; Department of Bioethics, U.S. National Institutes of Health, Bethesda, MD, USA
| | - Daniel Wang
- School of Law, Queen Mary University of London, London, UK
| | - Albert Weale
- Department of Political Science, University College London, London, UK
| | - James Wilson
- Department of Philosophy, University College London, London, UK
| | - Alicia Ely Yamin
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Georgetown University Law Center, Washington, DC, USA
| | - Paul Hunt
- School of Law, University of Essex, Colchester, Essex, UK
| |
Collapse
|
37
|
Kieslich K, Ahn J, Badano G, Chalkidou K, Cubillos L, Hauegen RC, Henshall C, Krubiner CB, Littlejohns P, Lu L, Pearson SD, Rid A, Whitty JA, Wilson J. Public participation in decision-making on the coverage of new antivirals for hepatitis C. J Health Organ Manag 2017; 30:769-85. [PMID: 27468625 DOI: 10.1108/jhom-03-2016-0035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose - New hepatitis C medicines such as sofosbuvir underline the need to balance considerations of innovation, clinical evidence, budget impact and equity in health priority-setting. The purpose of this paper is to examine the role of public participation in addressing these considerations. Design/methodology/approach - The paper employs a comparative case study approach. It explores the experience of four countries - Brazil, England, South Korea and the USA - in making coverage decisions about the antiviral sofosbuvir and involving the public and patients in these decision-making processes. Findings - Issues emerging from public participation ac tivities include the role of the universal right to health in Brazil, the balance between innovation and budget impact in England, the effect of unethical medical practices on public perception in South Korea and the legitimacy of priority-setting processes in the USA. Providing policymakers are receptive to these issues, public participation activities may be re-conceptualized as processes that illuminate policy problems relevant to a particular context, thereby promoting an agenda-setting role for the public. Originality/value - The paper offers an empirical analysis of public involvement in the case of sofosbuvir, where the relevant considerations that bear on priority-setting decisions have been particularly stark. The perspectives that emerge suggest that public participation contributes to raising attention to issues that need to be addressed by policymakers. Public participation activities can thus contribute to setting policy agendas, even if that is not their explicit purpose. However, the actualization of this contribution is contingent on the receptiveness of policymakers.
Collapse
Affiliation(s)
- Katharina Kieslich
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Jeonghoon Ahn
- Department of Health Management, Ewha Womans University, Seoul, South Korea
| | - Gabriele Badano
- Centre for Research in the Arts, Social Sciences and Humanities and Girton College, University of Cambridge, Cambridge, UK
| | | | - Leonardo Cubillos
- Dartmouth Hitchcock Medical Center, Dartmouth Medical School, Lebanon, New Hampshire, USA
| | - Renata Curi Hauegen
- Center for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Chris Henshall
- Health Economics Research Group, Brunel University London, London, UK
| | - Carleigh B Krubiner
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Lanting Lu
- School of Public Administration and Policy, Renmin University of China, Beijing, China
| | - Steven D Pearson
- The Institute for Clinical and Economic Review, Boston, Massachusetts, USA
| | - Annette Rid
- Department of Social Science, Health & Medicine, King's College London, London, UK
| | - Jennifer A Whitty
- Norwich Medical School, University of East Anglia, Norwich, UK and School of Pharmacy, University of Queensland, Brisbane, Australia
| | - James Wilson
- Department of Philosophy, University College London, London, UK
| |
Collapse
|
38
|
Charlton V, Littlejohns P, Kieslich K, Mitchell P, Rumbold B, Weale A, Wilson J, Rid A. Cost effective but unaffordable: an emerging challenge for health systems. BMJ 2017; 356:j1402. [PMID: 28330879 DOI: 10.1136/bmj.j1402] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Victoria Charlton
- Department of Global Health and Social Medicine, King's College London
| | - Peter Littlejohns
- Department of Primary Care and Public Health Sciences, King's College London
| | - Katharina Kieslich
- Department of Primary Care and Public Health Sciences, King's College London
| | | | | | - Albert Weale
- Department of Political Sciences, University College London
| | - James Wilson
- Department of Philosophy, University College London
| | - Annette Rid
- Department of Global Health and Social Medicine, King's College London
| |
Collapse
|
39
|
Wendler D, Rid A. In Defense of a Social Value Requirement for Clinical Research. Bioethics 2017; 31:77-86. [PMID: 28060427 PMCID: PMC5267934 DOI: 10.1111/bioe.12325] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/18/2016] [Accepted: 11/02/2016] [Indexed: 05/26/2023]
Abstract
Many guidelines and commentators endorse the view that clinical research is ethically acceptable only when it has social value, in the sense of collecting data which might be used to improve health. A version of this social value requirement is included in the Declaration of Helsinki and the Nuremberg Code, and is codified in many national research regulations. At the same time, there have been no systematic analyses of why social value is an ethical requirement for clinical research. Recognizing this gap in the literature, recent articles by Alan Wertheimer and David Resnik argue that the extant justifications for the social value requirement are unpersuasive. Both authors conclude, contrary to almost all current guidelines and regulations, that it can be acceptable across a broad range of cases to conduct clinical research which is known prospectively to have no social value. The present article assesses this conclusion by critically evaluating the ethical and policy considerations relevant to the claim that clinical research must have social value. This analysis supports the standard view that social value is an ethical requirement for the vast majority of clinical research studies and should be mandated by applicable guidelines and policies.
Collapse
|
40
|
|
41
|
Rumbold B, Weale A, Rid A, Wilson J, Littlejohns P. Public Reasoning and Health-Care Priority Setting: The Case of NICE. Kennedy Inst Ethics J 2017; 27:107-134. [PMID: 28366905 PMCID: PMC6728154 DOI: 10.1353/ken.2017.0005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Health systems that aim to secure universal patient access through a scheme of prepayments-whether through taxes, social insurance, or a combination of the two-need to make decisions on the scope of coverage that they guarantee: such tasks often falling to a priority-setting agency. This article analyzes the decision-making processes at one such agency in particular-the UK's National Institute for Health and Care Excellence (NICE)-and appraises their ethical justifiability. In particular, we consider the extent to which NICE's model can be justified on the basis of Rawls's conception of "reasonableness." This test shares certain features with the well-known Accountability for Reasonableness (AfR) model but also offers an alternative to it, being concerned with how far the values used by priority-setting agencies such as NICE meet substantive conditions of reasonableness irrespective of their procedural virtues. We find that while there are areas in which NICE's processes may be improved, NICE's overall approach to evaluating health technologies and setting priorities for health-care coverage is a reasonable one, making it an exemplar for other health-care systems facing similar coverage dilemmas. In so doing we offer both a framework for analysing the ethical justifiability of NICE's processes and one that might be used to evaluate others.
Collapse
|
42
|
Abstract
For the 2016 end-of-the-year editorial, the PLOS Medicine editors asked 7 global health leaders to discuss developments relevant to the equitable provision of medical care to all populations. The result is a collection of expert views on ethical trial design, research during outbreaks, high-burden infectious diseases, diversity in research and protection of migrants.
Collapse
Affiliation(s)
- The PLOS Medicine Editors
- Public Library of Science, San Francisco, California, United States of America
- Public Library of Science, Cambridge, United Kingdom
- * E-mail:
| | - Annette Rid
- Department of Global Health & Social Medicine, King’s College London, London, United Kingdom
| | - Michael A. Johansson
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- Center for Communicable Disease Dynamics, T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Gabriel Leung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hannah Valantine
- Office of the Director, National Institutes of Health, Bethesda, Maryland, United States of America
- Laboratory of Genome Transplantation, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Esteban G. Burchard
- Department of Bioengineering & Therapeutic Sciences, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Sam S. Oh
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
43
|
Dal-Ré R, Rid A, Emanuel E, Wendler D. Addressing exploitation of poor clinical trial participants in North America and the European Union. Eur J Intern Med 2016; 34:e37-e38. [PMID: 27425655 DOI: 10.1016/j.ejim.2016.06.026] [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: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/21/2022]
Affiliation(s)
- Rafael Dal-Ré
- Clinical Research, BUC (Biosciences UAM+CSIC) Program, International Campus of Excellence, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Annette Rid
- Department of Social Science, Health and Medicine, King's College, London, UK
| | - Ezekiel Emanuel
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - David Wendler
- Department of Bioethics, NIH Clinical Center, Bethesda, MD, USA
| |
Collapse
|
44
|
Cassel JB, Del Fabbro E, Arkenau T, Higginson IJ, Hurst S, Jansen LA, Poklepovic A, Rid A, Rodón J, Strasser F, Miller FG. Phase I Cancer Trials and Palliative Care: Antagonism, Irrelevance, or Synergy? J Pain Symptom Manage 2016; 52:437-45. [PMID: 27233136 DOI: 10.1016/j.jpainsymman.2016.02.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 02/06/2016] [Accepted: 02/26/2016] [Indexed: 12/19/2022]
Abstract
This article synthesizes the presentations and conclusions of an international symposium on Phase 1 oncology trials, palliative care, and ethics held in 2014. The purpose of the symposium was to discuss the intersection of three independent trends that unfolded in the past decade. First, large-scale reviews of hundreds of Phase I trials have indicated there is a relatively low risk of serious harm and some prospect of clinical benefit that can be meaningful to patients. Second, changes in the design and analysis of Phase I trials, the introduction of "targeted" investigational agents that are generally less toxic, and an increase in Phase I trials that combine two or more agents in a novel way have changed the conduct of these trials and decreased fears and apprehensions about participation. Third, the field of palliative care in cancer has expanded greatly, offering symptom management to late-stage cancer patients, and demonstrated that it is not mutually exclusive with disease-targeted therapies or clinical research. Opportunities for collaboration and further research at the intersection of Phase 1 oncology trials and palliative care are highlighted.
Collapse
Affiliation(s)
- J Brian Cassel
- Virginia Commonwealth University, Richmond, Virginia, USA.
| | | | - Tobias Arkenau
- Sarah Cannon Research Institute and University College London, London, United Kingdom
| | - Irene J Higginson
- Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Samia Hurst
- Institut d'éthique biomedicale, Centre médical universitaire, Geneva, Switzerland
| | - Lynn A Jansen
- Oregon Health and Science University, Portland, Oregon, USA
| | | | - Annette Rid
- King's College London, London, United Kingdom
| | - Jordi Rodón
- Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
| | | | | |
Collapse
|
45
|
Dal-Ré R, Rid A, Emanuel E, Wendler D. The potential exploitation of research participants in high income countries who lack access to health care. Br J Clin Pharmacol 2016; 81:857-64. [PMID: 26743927 PMCID: PMC4834591 DOI: 10.1111/bcp.12879] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 09/02/2015] [Revised: 12/25/2015] [Accepted: 01/03/2016] [Indexed: 11/30/2022] Open
Abstract
There are millions of individuals living in North America and the European Union who lack access to healthcare services. When these individuals participate in research, they are at increased risk of being exposed to the risks and burdens of clinical trials without realizing the benefits that result from them. The mechanisms that have been proposed to ensure that research participants in low- and middle-income countries are not exploited are unlikely to protect participants in high-income countries. The present manuscript argues that one way to address concerns about exploitation in high-income countries would be to require sponsors to provide targeted benefits such as medical treatment during the trial, or the study drug after the trial. The latter could be achieved through extension studies, expanded access programs, or named-patient programs. Sponsors also might provide non-medical benefits, such as education or social support. Ethical and regulatory guidance should be revised to ensure that research participants in high-income countries who lack access to healthcare services receive sufficient benefits.
Collapse
Affiliation(s)
- Rafael Dal-Ré
- Clinical Research, BUC (Biosciences UAM + CSIC) Program, International Campus of Excellence, Universidad Autónoma de Madrid, Madrid, Spain
| | - Annette Rid
- Department of Social Science, Health and Medicine, King's College, London, UK
| | - Ezekiel Emanuel
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania,, USA
| | - David Wendler
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| |
Collapse
|
46
|
Wendler D, Wesley R, Pavlick M, Rid A. Do Patients Want their Families or their Doctors to Make Treatment Decisions in the Event of Incapacity, and Why? AJOB Empir Bioeth 2016; 7:251-259. [PMID: 28944254 DOI: 10.1080/23294515.2016.1182235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Current practice relies on patient-designated and next-of-kin surrogates, in consultation with clinicians, to make treatment decisions for patients who lose the ability to make their own decisions. Yet, there is a paucity of data on whether this approach is consistent with patients' preferences regarding who they want to make treatment decisions for them in the event of decisional incapacity. METHODS Self-administered survey of patients at a tertiary care center. RESULTS Overall, 1169 respondents completed the survey (response rate=59.8%). Of the 229 respondents who had previously designated a surrogate, 78.2% wanted their surrogate to make treatment decisions in the event of decisional incapacity, whereas 21.8% wanted their doctors to make treatment decisions. Of the 822 respondents who had not designated a surrogate, 66.1% wanted their family to make treatment decisions, whereas 33.9% wanted their doctors to make treatment decisions. The most common explanation provided for why respondents wanted their surrogate or family to make treatment decisions for them in the event of decisional incapacity was the belief that loved ones knew the patient's treatment preferences. CONCLUSIONS Contrary to current practice, 33.9% of respondents who had not designated a surrogate, and 21.8% of those who had designated a surrogate indicated that they wanted their doctors to make treatment decisions for them in the event of decisional incapacity. Moreover, many of those who wanted their surrogates or family members to make treatment decisions explained this preference by citing a belief that loved ones knew the patient's treatment preferences. This belief is undermined by prior research which suggests that surrogates and family members frequently are unable to predict which treatments their charges would want. Future research should assess these two concerns with current practice and, where necessary, identify approaches to address them.
Collapse
Affiliation(s)
| | - Robert Wesley
- Biostatistics and Clinical Epidemiology, NIH Clinical Center
| | - Mark Pavlick
- St. Elizabeth's Hospital, Washington, District of Columbia
| | - Annette Rid
- Department of Social Science, Health & Medicine, King's College London
| |
Collapse
|
47
|
Wendler D, Wesley B, Pavlick M, Rid A. A new method for making treatment decisions for incapacitated patients: what do patients think about the use of a patient preference predictor? J Med Ethics 2016; 42:235-241. [PMID: 26825474 PMCID: PMC7388033 DOI: 10.1136/medethics-2015-103001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 01/07/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Surrogates frequently are unable to predict which treatment their charges would want and also can experience significant distress as a result of making treatment decisions. A new method, the patient preference predictor (PPP), has been proposed as a possible way to supplement the process of shared decision-making to address these two concerns. The PPP predicts which treatment the patient would want based on which treatment similar patients want in similar circumstances. The present article describes the results of the first evaluation to assess whether patients support the use of a PPP. METHODS Self-administered survey of patients at a tertiary care centre. RESULTS Overall, 1169 respondents completed the survey (response rate=59.8%). In the event that the respondent became unable to make decisions due to a car accident, 78.9% would want the PPP to be incorporated into the process of making treatment decisions for them. In contrast, 15.2% of respondents would not want the PPP to be used for them. Respondents who endorsed the PPP cited the possibility that its use could increase the chances that they receive the treatments they prefer and/or reduce the burdens on their surrogate decision-maker. CONCLUSIONS The majority of respondents endorsed the possibility of incorporating a PPP into the process of shared decision-making based on its potential to increase surrogates' predictive accuracy and/or reduce surrogate distress. These data provide strong patient support for further research to assess whether, in practice, the use of a PPP can increase the chances that incapacitated patients receive the treatments they prefer and reduce the burden of making decisions on their surrogates.
Collapse
Affiliation(s)
- David Wendler
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Bob Wesley
- Biostatistics & Clinical Epidemiology Service, NIH Clinical Center, Bethesda
| | | | - Annette Rid
- Department of Social Science, Health & Medicine, King’s College London, London, United Kingdom
| |
Collapse
|
48
|
Charles A, Rid A, Davies H, Draper H. Prisoners as research participants: current practice and attitudes in the UK. J Med Ethics 2016; 42:246-252. [PMID: 24958334 DOI: 10.1136/medethics-2012-101059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/29/2012] [Accepted: 04/01/2014] [Indexed: 06/03/2023]
Abstract
The use of prisoners as research participants is controversial. Efforts to protect them in response to past exploitation and abuse have led to strict regulations and reluctance to involve them as participants. Hence, prisoners are routinely denied the opportunity to participate in research. In the absence of comprehensive information regarding prisoners' current involvement in research, we examined UK prisoners' involvement through review of research applications to the UK National Research Ethics Service. We found that prisoners have extremely limited access to research participation. This analysis was augmented by a survey of those involved in research and research governance (UK researchers and Research Ethics Committee members). Our results suggest that pragmatic concerns regarding the perceived burden of including prisoners are far more prominent in motivating their exclusion than ethical concerns or knowledge of regulations. While prisoners may remain a vulnerable research population due to constraints upon their liberty and autonomy and the coercive nature of the prison environment, routine exclusion from participation may be disadvantageous. Rigorous ethical oversight and the shift in the prevailing attitude towards the risks and benefits of participation suggest that it may be time for research to be more accessible to prisoners in line with the principle of equivalence in prison healthcare. We suggest the necessary first step in this process is a re-examination of current guidance in the UK and other countries with exclusions.
Collapse
Affiliation(s)
- Anna Charles
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Annette Rid
- Institute of Biomedical Ethics, University of Zürich, Zürich, Switzerland Department of Social Science, Health and Medicine, King's College London, London, UK
| | - Hugh Davies
- National Research Ethics Service, London, UK
| | - Heather Draper
- Medicine, Ethics, Society and History (MESH), School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
49
|
Vayena E, Brownsword R, Edwards SJ, Greshake B, Kahn JP, Ladher N, Montgomery J, O'Connor D, O'Neill O, Richards MP, Rid A, Sheehan M, Wicks P, Tasioulas J. Research led by participants: a new social contract for a new kind of research. J Med Ethics 2016; 42:216-9. [PMID: 25825527 PMCID: PMC4819634 DOI: 10.1136/medethics-2015-102663] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/18/2015] [Indexed: 05/18/2023]
Abstract
In recent years, there have been prominent calls for a new social contract that accords a more central role to citizens in health research. Typically, this has been understood as citizens and patients having a greater voice and role within the standard research enterprise. Beyond this, however, it is important that the renegotiated contract specifically addresses the oversight of a new, path-breaking approach to health research: participant-led research. In light of the momentum behind participant-led research and its potential to advance health knowledge by challenging and complementing traditional research, it is vital for all stakeholders to work together in securing the conditions that will enable it to flourish.
Collapse
Affiliation(s)
- Effy Vayena
- Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland
| | | | | | - Bastian Greshake
- Department for Applied Bioinformatics, Institute for Cell Biology and Neuroscience, Goethe University, Frankfurt am Main, Germany
| | - Jeffrey P Kahn
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | - Onora O'Neill
- Department of Philosophy, Cambridge University, Cambridge, UK
| | | | - Annette Rid
- Department of Social Science, Health & Medicine,King's CollegeLondon, London, UK
| | - Mark Sheehan
- University of Oxford, The Ethox Centre, Oxford, UK
| | | | - John Tasioulas
- Yeoh Tiong Lay Centre for Politics, Philosophy and Law, Dickson Poon School of Law, King's College London, London, UK
| |
Collapse
|
50
|
Abstract
The 2014 Ebola virus epidemic is the largest and most severe ever recorded. With no approved vaccines or specific treatments for Ebola, clinical trials were launched within months of the epidemic in an unprecedented show of global partnership. One of these trials used a highly innovative "ring vaccination" design. The design was chosen for operational, scientific, and ethical reasons--in particular, it was regarded as ethically superior to individually randomized placebo-controlled trials. We scrutinize the ethical rationale for the ring vaccination design. We argue that the ring vaccination design is ethical but fundamentally equivalent to placebo-controlled designs with respect to withholding a potentially effective intervention from the control group. We discuss the implications for the ongoing ring vaccination trial and future research.
Collapse
Affiliation(s)
- Annette Rid
- Annette Rid is with the Department of Social Science, Health & Medicine, King's College London, London, UK. Franklin G. Miller is with the Division of Medical Ethics, Department of Public Health, Weill Cornell Medical College, New York, NY
| | - Franklin G Miller
- Annette Rid is with the Department of Social Science, Health & Medicine, King's College London, London, UK. Franklin G. Miller is with the Division of Medical Ethics, Department of Public Health, Weill Cornell Medical College, New York, NY
| |
Collapse
|