Guidelines for research practice in Australia: NHMRC Statement & Professional Codes

The guidelines for research practice with human participants offered in the National Health and Medical Research Council's 'Statement on Human Experimentation and Supplementary Notes' and a number of professions' Codes of Ethics were examined in terms of the principles of beneficence, respect for persons and justice. Clear differences emerged between the Professional Codes and the NHMRC Statement, particularly in the areas of confidentiality, reporting of research results and further use of data. The question of whether the NHMRC Statement is sufficiently comprehensive to guide research in many fields is considered.

Danish patients' attitudes to scientific-ethical questions. An interview study focusing therapeutic trials

One hundred and fourteen in- and out-patients from a department of internal medicine were interviewed, on the basis of a questionnaire with the following key questions: 1) Their attitudes to medical trials with man as the subject. 2) Their emphasis on informed consent. 3) Their attitudes to inclusion of patients not being able to give informed consent. 4) Their attitudes to tentative participation in 4 concrete projects. In all, 98% considered doctors' and patients' collaboration on new therapeutical methods both necessary and desirable. Eighty-eight per cent considered information of patients participating in trials a prerequisite. Eighty-six per cent accepted participation in scientific trials based on the guarantee of the doctors responsible. Of these 86%, 58% felt that a scientific-ethical committee's accept of the project implied an extra element of security. Seventy-five per cent replied that patients not being able to give informed consent themselves could be included in scientific trials. The majority, 77%, added that patients' relatives would then have to accept, 20% that such trials could be based on the participating doctors' responsibility, and only 2% that such a responsibility was to place on scientific-ethical committees. In the 4 concrete projects, answers followed a uniform trend: full information of patients was demanded by approximately 80%, and acceptance of participation resting with responsible doctors in more than 80%. Less than half of these 80% felt that evaluation by a scientific-ethical committee would add to patients' security.

Autonomy and audit--striking the balance

The Data Protection Act 1998 purports to implement European legislation which aims to protect the privacy of individuals. There were such concerns about the implications of the Act for certain research and audit that it became necessary to enact further legislation to enable such essential activities to continue. Although this empowers the Secretary of State for Health to approve proposals for these purposes, there should still be a requirement that the use of identifiable personal information without consent must be justified on compelling public interest grounds. It is this that can confound those seeking to rely on such justification. There can either be too cavalier an approach to the issue, and/or there is little sense of what considerations should come into play. This paper attempts to highlight some of the difficulties that are theoretically raised by some audit activities and set out the legal framework within which they must operate. However, the key focus is on how ethical considerations might inform the public interest argument.

The cloning controversy

Stem cell research has captured the imagination of many, including the scientific and medical community. But the medical community received a wake-up call early this year when a well-known researcher publicly confessed to deception. While the core question relates to honesty and integrity, it is equally necessary to examine the system that made such deception possible.

Aristotle's biopolitics: a defense of biological teleology against biological nihilism

Modern Darwinian biology seems to promote nihilism, for it seems to teach that there is no rationally discoverable standard in nature for giving meaning to life. The purpose of this article is to argue for a revival of Aristotle's biological teleology as a reasonable alternative to biological nihilism. The article begins with Edward Wilson's vain struggle against nihilism. Then it is argued that a teleological understanding of nature is assumed in the practice of medicine, as illustrated by one case from Oliver Sacks' neurological practice. The article then considers the importance of biological teleology for Aristotle's moral and political philosophy, and attention is given to some points of agreement and disagreement with contemporary sociobiologists. The main part of the article is then devoted to a defense of Aristotle's biology against the five objections that might be made by a Darwinian biologist. Finally, the article illustrates the practical implications of this issue for bioethics by considering the recent work of Engelhardt.

Research note: ethics of drug treatment research with court-supervised subjects

The last two decades have seen an acceleration of clinical research on, and treatment advances in, addictive illness. Much important research in this area requires the participation of subjects who themselves suffer from drug dependence and have a strong likelihood of becoming involved in the criminal justice system at some point. However, using court-supervised persons with addictive disorders in drug research raises a number of significant ethical issues. These include, among others, worries about the individual's ability to provide capable, voluntary, informed consent and the obligation of researchers to safeguard sensitive clinical information. A variety of potentially coercive factors can influence court-supervised persons in their decision whether to enter research and can compromise their ability to provide informed consent. In this paper, we explore the ethical issues arising in this research and offer some suggestions for approaches to address these concerns.

The research misconception

Recently, several researchers and philosophers argued that clinical research trials are not therapy. Their position is based on foundational research ethics documents, such as the Belmont Report, on conceptual analysis, and on the general way clinical trials are conducted. After examining and rejecting these arguments, we claim that good research is consistent with good therapy; that often trials are good therapy; and that a blanket attack on clinical trials as non-therapeutic creates a research misconception. This misconception is potentially harmful because it could weaken trial recruitment, could adversely affect funding for trials, and could overturn needed moral safeguards on therapeutic trials. Our more careful and accurate analysis of the nature of clinical trials can avoid such problems.

North-South benefit sharing arrangements in bioprospecting and genetic research: a critical ethical and legal analysis

Most pharmaceutical research carried out today is focused on the treatment and management of the lifestyle diseases of the developed world. Diseases that affect mainly poor people are neglected in research advancements in treatment because they cannot generate large financial returns on research and development costs. Benefit sharing arrangements for the use of indigenous resources and genetic research could only marginally address this gap in research and development in diseases that affect the poor. Benefit sharing as a strategy is conceptually problematic, even if one, as we do, agrees that impoverished indigenous communities should not be exploited and that they should be assisted in improving their living conditions. The accepted concept of intellectual property protection envisages clearly defined originators and owners of knowledge, whereas the concept of community membership is fluid and indigenous knowledge is, by its very nature, open, with the originator(s) lost in the mists of time. The delineation of 'community' presents serious conceptual and practical difficulties as few communities form discrete, easily discernable groups, and most have problematic leadership structures. Benefit sharing is no substitute for governments' responsibility to uplift impoverished communities. Benefit sharing arrangements may be fraught with difficulties but considerations of respect and equity demand that prior informed consent and consultation around commercialisation of knowledge take place with the source community and their government.

Biodiversity, biopiracy and benefits: what allegations of biopiracy tell us about intellectual property

This paper examines the concept of biopiracy, which initially emerged to challenge various aspects of the regime for intellectual property rights (IPR) in living organisms, as well as related aspects pertaining to the ownership and apportioning of benefits from 'genetic resources' derived from the world's biodiversity. This paper proposes that we take the allegation of biopiracy seriously due to the impact it has as an intervention which indexes a number of different, yet interrelated, problematizations of biodiversity, biotechnology and IPR. Using the neem tree case as an example, it describes activists' use of the term as one that involves a deliberate simplification of science and IPR. Additionally, it argues that in so doing, biopiracy is positioned as a touchstone that mobilizes actors and problems, and ultimately generates 'solutions' to the very challenges it creates. The paper will also encourage a view of biopiracy claims that does not always treat them simply as claims of theft, or as a misallocation of benefits, but rather as claims that are designed to raise broader questions about the IPR system itself. It concludes by advocating that, in order to properly understand how to address biopiracy, we must be prepared to move beyond the current narrow readings to develop a more complete picture of the term's influence in challenging how, and by whom, the decisions about what is natural and what is invented come to be made.

Vicissitudes of benefit sharing of crop genetic resources: downstream and upstream

In this article, we will first give a historic overview of the concept of benefit sharing and its appearance in official agreements, particularly with respect to crop genetic resources. It will become clear that, at present, benefit sharing is primarily considered as an instrument of compensation or exchange, and thus refers to commutative justice. However, we believe that such a narrow interpretation of benefit sharing disregards, and even undermines, much of its (historical) content and potency, especially where crop genetic resources are concerned. We argue that benefit sharing should not be based merely on commutative justice but rather on a broader model that is also grounded in the concept of distributive justice. This has repercussions for the application of benefit sharing, which we try to clarify by distinguishing between downstream and upstream benefit sharing. Upstream benefit sharing is not so much inspired by compensation for actions done, or the distribution downstream of benefits developed, but by the idea of shared decision-making on the research and development of resources fundamental to human welfare. Going upstream in the research process of crop genetic resources, and determining research agendas and improving crops according to the needs of the poor, benefit sharing may well be a tool to contribute to world food security and global justice. We concretize our ideas on upstream benefit sharing by introducing a set of criteria that determine the success of consultations on agricultural research agenda setting.

Sharing the benefits of genetic resources: from biodiversity to human genetics

Benefit sharing aims to achieve an equitable exchange between the granting of access to a genetic resource and the provision of compensation. The Convention on Biological Diversity (CBD), adopted at the 1992 Earth Summit in Rio de Janeiro, is the only international legal instrument setting out obligations for sharing the benefits derived from the use of biodiversity. The CBD excludes human genetic resources from its scope, however, this article considers whether it should be expanded to include those resources, so as to enable research subjects to claim a share of the benefits to be negotiated on a case-by-case basis. Our conclusion on this question is: 'No, the CBD should not be expanded to include human genetic resources.' There are essential differences between human and non-human genetic resources, and, in the context of research on humans, an essentially fair exchange model is already available between the health care industry and research subjects. Those who contribute to research should receive benefits in the form of accessible new health care products and services, suitable for local health needs and linked to economic prosperity (e.g. jobs). When this exchange model does not apply, as is often the case in developing countries, individually negotiated benefit sharing agreements between researchers and research subjects should not be used as 'window dressing'. Instead, national governments should focus their finances on the best economic investment they could make; the investment in population health and health research as outlined by the World Health Organization's Commission on Macroeconomics and Health; whilst international barriers to such spending need to be removed.

Research misconduct policies of high impact biomedical journals

Several national and international organizations have recommended policies regarding journal responsibilities about research misconduct in submitted or published manuscripts. A search of Web sites of the fifty highest impact journals in a cluster of biomedical fields and a limited survey of their editors shows that few journals have formally adopted standards for dealing with questions of research misconduct. Publicly available policies may have a deterrent effect and can prevent arbitrariness in handling cases.

Consenting of the vulnerable: the informed consent procedure in advanced cancer patients in Mexico

BACKGROUND

A topic of great concern in bioethics is the medical research conducted in poor countries sponsored by wealthy nations. Western drug companies increasingly view Latin America as a proper place for clinical research trials. The region combines a large population, modern medical facilities, and low per capita incomes. Participants from developing countries may have little or non alternative means of treatment other than that offered through clinical trials. Therefore, the provision of a valid informed consent is important.

METHODS

To gain insight about some aspects of the informed consent procedure in a major cancer centre in Mexico, we conducted a three-step evaluation process: 1) a ten point multiple choice survey questionnaires, was used to explore some aspects of the patients' experiences during the informed consent process, 2) researchers' knowledge about specific aspects of the informed consent was evaluated in this study using survey questionnaires; and 3) the comprehensibility, readability and number of pages of the consent forms were analysed. The socioeconomic and educational level of the patients, were also considered. Results were reported using a numerical scale.

RESULTS

Thirty five patients, 20 doctors, and 10 individuals working at the hospital agreed to participate in the study. Eighty three percent of the patients in the study were classified as living in poverty; education level was poor or non existent, and 31% of the patients were illiterate. The consent forms were difficult to understand according to 49% of the patients, most doctors agreed that the forms were not comprehensible to the patients. The average length of the IC documents analysed was 14 pages, and the readability average score was equivalent to 8th grade.

CONCLUSION

The results presented in this work describe some relevant characteristics of the population seen at public health care institutions in Mexico. Poverty, limited or no education, and the complexity of the information provided to the patients may question the validity of the informed consent procedure in this group of patients.

Washington insider

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Human life: genetic or social construction?

I am going to discuss some present-day tendencies in the development of the very old debate on nature vs nurture. There is a widespread position describing the history of this debate as a pendulum-like process. Some three decades ago there was a time of overwhelming prevalence of the position stressing social factors in determining human character and behavior; now the pendulum has come to the opposite side and those who stress the role of biology, of genes are in favor. Yet in my view rather acute opposition of both positions still exists. Its existence depends not so much on new scientific discoveries as on some social and cultural factors which are more conservative than the development of science. More than that, we can even talk about competition of these two positions.

Ethical issues in field research: balancing competing values

An ethical issue becomes a dilemma when the psychologist is pulled in different directions by competing values. This paper will focus on the conflict between experimental and ethical values inherent in field research. The problem has special significance in community psychology, which gives priority to studying, in natural settings, those affected by social problems. An example is given of research that required observation of family interaction in the homes of convicted child abusers. The case demonstrates that the value of ecological validity often conflicts with the need to protect privacy and obtain uncoerced consent. Other ethical constraints, including the duty to report lawbreaking and to protect the public from harm, may threaten research validity.

Bodyworlds and the ethics of using human remains: a preliminary discussion

Accepting the claim that the living have some moral duties with regard to dead bodies, this paper explores those duties and how they bear on the popular travelling exhibition Bodyworlds. I argue that the concept of informed consent presupposes substantial duties to the dead, namely duties that reckon with the meaning of the act in question. An attitude of respect and not regarding human remains as mere raw material are non-alienable substantial duties. I found the ethos of Bodyworlds premature but full of promises such as public attitudes to organ donations. At the practical level I conclude that Bodyworlds should use only willed donations or unclaimed bodies for which dignified funerals are not available. In the case of live donations, Bodyworlds has a duty to participate in the medical care of needy donors. However, secrecy with regard to the source of cadavers seems to be the most troublesome aspect of Bodyworlds.

Protecting communities in health research from exploitation

Guidelines for health research focus on protecting individual research subjects. Yet several commentators have argued that protecting individual subjects, while undoubtedly important, is not sufficient to ensure ethical research. It is also vital to protect the communities involved in health research. In particular, a number of studies have been criticized on the grounds that they exploited host communities. Although these criticisms have received a good deal of attention, there has been no systematic analysis of what constitutes community exploitation in health research, nor an assessment of what safeguards are needed to protect against it. This is a serious deficiency. The absence of an analysis of community exploitation makes it impossible to ensure that host communities are protected against exploitation. The absence of an analysis also raises the possibility that charges of exploitation may block important research, without any way of assessing whether the charges are warranted. The present paper attempts to address these concerns by providing an analysis of community exploitation and, based on this analysis, determining what safeguards are needed to protect communities in health research against exploitation.

Procedural misconceptions and informed consent: insights from empirical research on the clinical trials industry

This paper provides a simultaneously reflexive and analytical framework to think about obstacles to truly informed consent in social science and biomedical research. To do so, it argues that informed consent often goes awry due to procedural misconceptions built into the research context. The concept of procedural misconception is introduced to describe how individuals respond to what is familiar in research settings and overlook what is different. In the context of biomedical research, procedural misconceptions can be seen to function as root causes of therapeutic misconceptions.

Rating methodological quality: toward improved assessment and investigation

Assessing methodological quality is considered essential in deciding what investigations to include in research syntheses and in detecting potential sources of bias in meta-analytic results. Quality assessment is also useful in characterizing the strengths and limitations of the research in an area of study. Although numerous instruments to measure research quality have been developed, they have lacked empirically-supported components. In addition, different summary quality scales have yielded different findings when they were used to weight treatment effect estimates for the same body of research. Suggestions for developing improved quality instruments include: distinguishing distinct domains of quality, such as internal validity, external validity, the completeness of the study report, and adherence to ethical practices; focusing on individual aspects, rather than domains of quality; and focusing on empirically-verified criteria. Other ways to facilitate the constructive use of quality assessment are to improve and standardize the reporting of research investigations, so that the quality of studies can be more equitably and thoroughly compared, and to identify optimal methods for incorporating study quality ratings into meta-analyses.

One standard of care for all is not always practical

Multiple research guidelines address the issue of standard of care in international collaborative research. These guidelines fail to appreciate that differing standards may be present within the same country, which makes their application sometimes impracticable. In circumstances where ethics review committees follow one of these guidelines entirely and to the hilt, some relevant and useful research is rejected while the way for "me too" drug trials is paved. It should be acceptable to hold different researchers to separate standards of care on the basis of their intentions, their financial resources, their ultimate gains from the research, and subsequent utilisation of the results of the research, even when these researchers come from the same country where the research is being conducted.

Do aid agencies have an ethical duty to comply with researchers? A response to Rennie

Medical AID organisations such as Médecins Sans Frontières receive several requests from individuals and international academic institutions to conduct research at their implementation sites in Africa. Do AID agencies have an ethical duty to comply with research requests? In this paper we respond to the views and constructed theories (albeit unfounded) of one such researcher, whose request to conduct research at one of our sites in the Democratic Republic of Congo was turned down.

Descriptive ethics: a qualitative study of local research ethics committees in Mexico

OBJECTIVE

To describe how local research ethics committees (LRECs) consider and apply research ethics in the evaluation of biomedical research proposals.

DESIGN

A qualitative study was conducted using purposeful sampling, focus groups and a grounded theory approach to generate data and to analyse the work of the LRECs.

SETTING AND PARTICIPANTS

11 LRECs of the Mexican Institute of Social Security (IMSS).

RESULTS

LRECs considered ethics to be implicit in all types of research, but that ethics reviews were only necessary for projects that included the direct participation of human beings. The LRECs appeared to understand the importance of consent, as in the completion of a consent form, but did not emphasise the importance of the process of acquiring 'informed' consent. The committees considered their main roles or functions to be: (a) to improve the methodological quality of research and to verify - if applicable - the ethical aspects; (b) to encourage personnel to undergo research training; (c) to follow-up research to oversee the adherence to norms and compliance with a specified research timetable.

CONCLUSIONS

This study provides a valuable insight into how these LRECs understand the ethical review process. The emphasis of the committees was on rules, regulations, improving research methodology and research training, rather than a focus on efforts to protect the rights and well being of research subjects. The results encourage further normative and descriptive lines of investigation concerning education and the development of LRECs.