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Buckey TM, Feldman SF, Apter AJ. An Ethical Framework for Allergy and Immunology. J Allergy Clin Immunol Pract 2024; 12:1153-1158. [PMID: 38395255 DOI: 10.1016/j.jaip.2024.02.018] [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] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Ethical dilemmas routinely occur in the clinical practice of allergy and immunology. These ethical questions stem from the range of conditions and the different populations cared for by Allergists/Immunologists. Hence, medical ethics is not an esoteric concept, but a practical skill physicians exercise regularly. Moreover, an ethics-centered approach may improve patient safety and outcomes. This article describes key principles of bioethics and illustrates an ethical framework that physicians can use in their conversations with patients. Utilization of this ethical framework is demonstrated through applying it to 4 unique clinical scenarios encountered by Allergists/Immunologists from different practice settings. The ethical framework for allergy and immunology is a technique to navigate ethically complex decisions that arise in routine clinical practice.
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Affiliation(s)
- Timothy M Buckey
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Scott F Feldman
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrea J Apter
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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2
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Yarborough BJH, Stumbo SP. A Stakeholder-Informed Ethical Framework to Guide Implementation of Suicide Risk Prediction Models Derived from Electronic Health Records. Arch Suicide Res 2023; 27:704-717. [PMID: 35446244 PMCID: PMC9665102 DOI: 10.1080/13811118.2022.2064255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Develop a stakeholder-informed ethical framework to provide practical guidance to health systems considering implementation of suicide risk prediction models. METHODS In this multi-method study, patients and family members participating in formative focus groups (n = 4 focus groups, 23 participants), patient advisors, and a bioethics consultant collectively informed the development of a web-based survey; survey results (n = 1,357 respondents) and themes from interviews with stakeholders (patients, health system administrators, clinicians, suicide risk model developers, and a bioethicist) were used to draft the ethical framework. RESULTS Clinical, ethical, operational, and technical issues reiterated by multiple stakeholder groups and corresponding questions for risk prediction model adopters to consider prior to and during suicide risk model implementation are organized within six ethical principles in the resulting stakeholder-informed framework. Key themes include: patients' rights to informed consent and choice to conceal or reveal risk (autonomy); appropriate application of risk models, data and model limitations and consequences including ambiguous risk predictors in opaque models (explainability); selecting actionable risk thresholds (beneficence, distributive justice); access to risk information and stigma (privacy); unanticipated harms (non-maleficence); and planning for expertise and resources to continuously audit models, monitor harms, and redress grievances (stewardship). CONCLUSIONS Enthusiasm for risk prediction in the context of suicide is understandable given the escalating suicide rate in the U.S. Attention to ethical and practical concerns in advance of automated suicide risk prediction model implementation may help avoid unnecessary harms that could thwart the promise of this innovation in suicide prevention. HIGHLIGHTSPatients' desire to consent/opt out of suicide risk prediction models.Recursive ethical questioning should occur throughout risk model implementation.Risk modeling resources are needed to continuously audit models and monitor harms.
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Campbell S, Carnevale FA. Children as an afterthought during COVID-19: defining a child-inclusive ethical framework for pandemic policymaking. BMC Med Ethics 2022; 23:126. [PMID: 36471326 PMCID: PMC9720957 DOI: 10.1186/s12910-022-00866-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 11/23/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Following the SARS pandemic, jurisdictions around the world began developing ethical resource allocation frameworks for future pandemics-one such framework was developed by Thompson and colleagues. While this framework offers a solid backbone upon which decision-makers can rest assured that their work is driven by rigorous ethical processes and principles, it fails to take into account the nuanced experiences and interests of children and youth (i.e., young people) in a pandemic context. The current COVID-19 pandemic offers an opportunity to re-examine this framework from young people's perspectives, informed by advances in childhood ethics and children's rights. MAIN BODY In this paper, we revisit the Thompson et al. framework and propose adaptations to the ethical processes and values outlined therein. This work is informed by expertise in clinical ethics and literature related to impacts of COVID-19 and other pandemics on the health and well-being of children around the world, though with particular attention to Canada. During the processes of drafting this work, stakeholders were consulted-aligned with the approach used by Thompson and colleagues-to validate the interpretations provided. We also propose a new principle, namely practicability, to indicate the complex balance between what is possible and what is convenient that is required in ethically sound decisions in the context of services affecting young people. We outline and discuss the strengths and limitations of our work and indicate next steps for scholars in the areas of childhood studies and child health. CONCLUSION Efforts to ensure frameworks are truly child-inclusive should be the status-quo, so pandemic impacts and policy implications can be considered in advance of emergency preparedness contexts.
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Affiliation(s)
- Sydney Campbell
- grid.14709.3b0000 0004 1936 8649VOICE Childhood Ethics Research Team, McGill University, Montreal, QC Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M573M6 Canada ,grid.17063.330000 0001 2157 2938Joint Centre for Bioethics, University of Toronto, Toronto, Canada
| | - Franco A. Carnevale
- grid.14709.3b0000 0004 1936 8649VOICE Childhood Ethics Research Team, McGill University, Montreal, QC Canada ,grid.14709.3b0000 0004 1936 8649Ingram School of Nursing, McGill University, Montreal, QC Canada
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Afroogh S, Esmalian A, Mostafavi A, Akbari A, Rasoulkhani K, Esmaeili S, Hajiramezanali E. Tracing app technology: an ethical review in the COVID-19 era and directions for post-COVID-19. Ethics Inf Technol 2022; 24:30. [PMID: 35915595 PMCID: PMC9330978 DOI: 10.1007/s10676-022-09659-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
We conducted a systematic literature review on the ethical considerations of the use of contact tracing app technology, which was extensively implemented during the COVID-19 pandemic. The rapid and extensive use of this technology during the COVID-19 pandemic, while benefiting the public well-being by providing information about people's mobility and movements to control the spread of the virus, raised several ethical concerns for the post-COVID-19 era. To investigate these concerns for the post-pandemic situation and provide direction for future events, we analyzed the current ethical frameworks, research, and case studies about the ethical usage of tracing app technology. The results suggest there are seven essential ethical considerations-privacy, security, acceptability, government surveillance, transparency, justice, and voluntariness-in the ethical use of contact tracing technology. In this paper, we explain and discuss these considerations and how they are needed for the ethical usage of this technology. The findings also highlight the importance of developing integrated guidelines and frameworks for implementation of such technology in the post- COVID-19 world. Supplementary Information The online version contains supplementary material available at 10.1007/s10676-022-09659-6.
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Affiliation(s)
- Saleh Afroogh
- Department of Philosophy, The State University of New York at Albany, Albany, NY 12203 USA
| | - Amir Esmalian
- UrbanResilience.AI Lab, Zachry Department of Civil and Environmental Engineering, Texas A&M University, College Station, TX 77840 USA
| | - Ali Mostafavi
- UrbanResilience.AI Lab, Zachry Department of Civil and Environmental Engineering, Texas A&M University, College Station, TX 77840 USA
| | - Ali Akbari
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77840 USA
| | | | - Shahriar Esmaeili
- Department of Physics and Astronomy, Texas A&M University, College Station, TX 77843 USA
| | - Ehsan Hajiramezanali
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX USA
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Lysaght T, Schaefer GO, Voo TC, Wee HL, Joseph R. Professional Oversight of Emergency-Use Interventions and Monitoring Systems: Ethical Guidance From the Singapore Experience of COVID-19. J Bioeth Inq 2022; 19:327-339. [PMID: 35420376 PMCID: PMC9008394 DOI: 10.1007/s11673-022-10171-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
High degrees of uncertainty and a lack of effective therapeutic treatments have characterized the COVID-19 pandemic and the provision of drug products outside research settings has been controversial. International guidelines for providing patients with experimental interventions to treat infectious diseases outside of clinical trials exist but it is unclear if or how they should apply in settings where clinical trials and research are strongly regulated. We propose the Professional Oversight of Emergency-Use Interventions and Monitoring System (POEIMS) as an alternative pathway based on guidance developed for the ethical provision of experimental interventions to treat COVID-19 in Singapore. We support our proposal with justifications that establish moral duties for physicians to record outcomes data and for institutions to establish monitoring systems for reporting information on safety and effectiveness to the relevant authorities. Institutions also have a duty to support generation of evidence for what constitutes good clinical practice and so should ensure the unproven intervention is made the subject of research studies that can contribute to generalizable knowledge as soon as practical and that physicians remain committed to supporting learning health systems. We outline key differences between POEIMS and other pathways for the provision of experimental interventions in public health emergencies.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Yong Yoo Lin School of Medicine, Clinical Research Centre MD 11 #02-03, National University of Singapore, 10 Medical Drive, Singapore, Singapore
| | - Gerald Owen Schaefer
- Centre for Biomedical Ethics, Yong Yoo Lin School of Medicine, Clinical Research Centre MD 11 #02-03, National University of Singapore, 10 Medical Drive, Singapore, Singapore
| | - Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Yoo Lin School of Medicine, Clinical Research Centre MD 11 #02-03, National University of Singapore, 10 Medical Drive, Singapore, Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Roy Joseph
- Centre for Biomedical Ethics, Yong Yoo Lin School of Medicine, Clinical Research Centre MD 11 #02-03, National University of Singapore, 10 Medical Drive, Singapore, Singapore
- Department of Paediatrics, National University Hospital, Singapore, Singapore
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6
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Bærøe K, Kerasidou A, Dunn M, Teig IL. Pursuing impact in research: towards an ethical approach. BMC Med Ethics 2022; 23:37. [PMID: 35387625 PMCID: PMC8988365 DOI: 10.1186/s12910-022-00754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research proactively and deliberately aims to bring about specific changes to how societies function and individual lives fare. However, in the ever-expanding field of ethical regulations and guidance for researchers, one ethical consideration seems to have passed under the radar: How should researchers act when pursuing actual, societal changes based on their academic work? MAIN TEXT When researchers engage in the process of bringing about societal impact to tackle local or global challenges important concerns arise: cultural, social and political values and institutions can be put at risk, transformed or even hampered if researchers lack awareness of how their 'acting to impact' influences the social world. With today's strong focus on research impacts, addressing such ethical challenges has become urgent within in all fields of research involved in finding solutions to the challenges societies are facing. Due to the overall goal of doing something good that is often inherent in ethical approaches, boundaries to researchers' impact of something good is neither obvious, nor easy to detect. We suggest that it is time for the field of bioethics to explore normative boundaries for researchers' pursuit of impact and to consider, in detail, the ethical obligations that ought to shape this process, and we provide a four-step framework of fair conditions for such an approach. Our suggested approach within this field can be useful for other fields of research as well. CONCLUSION With this paper, we draw attention to how the transition from pursuing impact within the Academy to trying to initiate and achieve impact beyond the Academy ought to be configured, and the ethical challenges inherent in this transition. We suggest a stepwise strategy to identify, discuss and constitute consensus-based boundaries to this academic activity. This strategy calls for efforts from a multi-disciplinary team of researchers, advisors from the humanities and social sciences, as well as discussants from funding institutions, ethical committees, politics and the society in general. Such efforts should be able to offer new and useful assistance to researchers, as well as research funding agencies, in choosing ethically acceptable, impact-pursuing projects.
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Affiliation(s)
- Kristine Bærøe
- Department of Global Public Health and Primary Care, University of Bergen, Postbox 7804, 5020, Bergen, Norway.
| | - Angeliki Kerasidou
- Ethox Centre, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michael Dunn
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore
| | - Inger Lise Teig
- Department of Global Public Health and Primary Care, University of Bergen, Postbox 7804, 5020, Bergen, Norway
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Baskin AS, Wang T, Miller J, Jagsi R, Kerr EA, Dossett LA. A Health Systems Ethical Framework for De-implementation in Health Care. J Surg Res 2021; 267:151-158. [PMID: 34153558 PMCID: PMC8678146 DOI: 10.1016/j.jss.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/19/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Unnecessary health care not only drive up costs, but also contribute to avoidable patient harms, underscoring an ethical obligation to eliminate practices which are harmful, lack evidence, and prevent spending on more beneficial services. To date, de-implementation ethics discussions have been limited and focused on clinical ethics principles. An analysis of de-implementation ethics in the broader context of the health care system is lacking. METHODS To better understand the ethical considerations of de-implementation, recognizing it as a health care systems issue, we applied Krubiner and Hyder's bioethical framework for health systems activity. We examine ethics principles relevant to de-implementation, which either call for or facilitate the reduction of low value surgery. RESULTS AND DISCUSSION From 11 health systems principles proposed by Krubiner and Hyder, we identified the 5 principles most pertinent to the topic of de-implementation: evidence and effectiveness, transparency and public engagement, efficiency, responsiveness, and collaboration. An analysis of de-implementation through the lens of these principles not only supports de-implementation but proves an obligation at the health system level to eliminate low value care. Recognizing the challenge of defining "value," the proposed framework may increase the legitimacy and objectivity of de-implementation. CONCLUSIONS While there is no single ideal ethical framework from which to approach de-implementation, a health systems framework allows for consideration of the systems-level factors impacting de-implementation. Framing de-implementation as a health systems issue with systems-wide ethical implications empowers providers to think about new ways to approach potential roadblocks to reducing low-value care.
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Affiliation(s)
| | - Ton Wang
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Reshma Jagsi
- Department of Radiation Oncology,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - Eve A Kerr
- Department of Internal Medicine , Center for Clinical Management Research, Ann Arbor, MI
| | - Lesly A Dossett
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI.
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Abstract
The recently published BRAIN 2.0 Neuroethics Report offers a very helpful overview of the possible ethical, social, philosophical, and legal issues raised by neuroscience in the context of BRAIN's research priorities thus contributing to the attempt to develop ethically sound neuroscience. In this article, we turn to a running theme of the document: the need for an ethical framework for the BRAIN Initiative and for further integration of neuroethics and neuroscience. We assess some of the issues raised and provide an explanation of how we have addressed them in the Human Brain Project. We offer our experience in the HBP as a potential contribution to the international debate about neuroethics in the big brain initiatives. Our hope is that among other things, the type of exchange proposed by this AJOB special issue will prove productive in further identifying and discussing the issues and in inspiring appropriate solutions.
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Affiliation(s)
- Arleen Salles
- Uppsala University.,Centro de Investigaciones Filosoficas
| | - Michele Farisco
- Uppsala University.,Biogem, Biology and Molecular Genetics Institute
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9
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Jaarsma P, Gelhaus P. Medium-Range Narratives as a Complementary Tool to Principle-Based Prioritization in Sweden: Test Case "ADHD". J Bioeth Inq 2019; 16:113-125. [PMID: 30519994 PMCID: PMC6474850 DOI: 10.1007/s11673-018-9884-3] [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] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023]
Abstract
In this paper, for the benefit of reflection processes in clinical and in local, regional, and national priority-setting, we aim to develop an ethical theoretical framework that includes both ethical principles and medium-range narratives. We present our suggestion in the particular case of having to choose between treatment interventions for attention deficit hyperactivity disorder (ADHD) and treatment interventions for other conditions or diseases, under circumstances of scarcity. In order to arrive at our model, we compare two distinct ethical approaches: a generalist (principles) approach and a particularist (narratives) approach. Our focus is on Sweden, because in Sweden prioritization in healthcare is uniquely governmentally regulated by the "ethics platform." We will present a (fictional) scenario to analyse the strengths and weaknesses of the generalist principled perspective of the ethics platform and the particularist perspective of narrative ethics. We will suggest an alternative (moderately particularist) approach to prioritization, which we dub a "principles plus medium-range narratives" approach. Notwithstanding the undeniably central role of principles in distributive justice, we claim that medium-range narratives concerning individuals or groups who stand to benefit or lose from ADHD prioritization practices should also be read or listened to and taken into account at all levels of priority-setting. These narratives are expected to ethically optimize clinical priority-setting, as well as that undertaken at local, regional, and national levels.
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Affiliation(s)
- Pier Jaarsma
- Division of Health Care Analysis, Department of Medical and Health Sciences (IMH), University of Linköping, Malmstigen 13, 58941, Linköping, Sweden.
| | - Petra Gelhaus
- Institute for Ethics, History and Philosophy of Medicine, University of Muenster, Muenster, Germany
- , Borghamn, Sweden
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10
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Abstract
In surveying the medical literature on Islamic principles of research ethics, it is apparent that attempts to identify ethical principles are replete with issues of standards and gaps in knowledge of the uses of scriptural sources. Despite this, attempts at creating an Islamic ethical framework for research ethics may improve current practices in research in Muslim-majority countries and contribute to the growing canon of secular bioethics. This paper aims to identify principles and considerations within Islam that (1) overlap with current corpora on research ethics, and (2) further informs the current research ethics discourse.
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Affiliation(s)
- Abbas Rattani
- Stritch School of Medicine, Loyola University Chicago, 2160 S 1st Ave., Maywood, IL, 60153, USA.
| | - Adnan A Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E-8132, Baltimore, MD, 21093, USA
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Avenue, Baltimore, MD, 21205, USA
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Sambala EZ, Kanyenda T, Iwu CJ, Iwu CD, Jaca A, Wiysonge CS. Pandemic influenza preparedness in the WHO African region: are we ready yet? BMC Infect Dis 2018; 18:567. [PMID: 30428846 PMCID: PMC6236890 DOI: 10.1186/s12879-018-3466-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 05/23/2018] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background Prior to the 2009 pandemic H1N1, and the unprecedented outbreak of Highly Pathogenic Avian Influenza (HPAI) caused by the H5N1 virus, the World Health Organization (WHO) called upon its Member States to develop preparedness plans in response to a new pandemic in humans. The WHO Member States responded to this call by developing national pandemic plans in accordance with the International Health Regulations (IHR) to strengthen the capabilities of Member States to respond to different pandemic scenarios. In this study, we aim to evaluate the quality of the preparedness plans in the WHO African region since their inception in 2005. Methods A standard checklist with 61 binary indicators (“yes” or “no”) was used to assess the quality of the preparedness plans. The checklist was categorised across seven thematic areas of preparedness: preparation (16 indicators); coordination and partnership (5 indicators); risk communication (8 indicators); surveillance and monitoring (7 indicators); prevention and containment (10 indicators); case investigation and treatment (10 indicators) and ethical consideration (5 indicators). Four assessors independently scored the plans against the checklist. Results Of the 47 countries in the WHO African region, a total of 35 national pandemic plans were evaluated. The composite score for the completeness of the pandemic plans across the 35 countries was 36%. Country-specific scores on each of the thematic indicators for pandemic plan completeness varied, ranging from 5% in Côte d’Ivoire to 79% in South Africa. On average, preparation and risk communication scored 48%, respectively, while coordination and partnership scored the highest with an aggregate score of 49%. Surveillance and monitoring scored 34%, while prevention and containment scored 35%. Case investigation and treatment scored 25%, and ethical consideration scored the lowest of 14% across 35 countries. Overall, our assessment shows that pandemic preparedness plans across the WHO African region are inadequate. Conclusions Moving forward, these plans must address the gaps identified in this study and demonstrate clarity in their goals that are achievable through drills, simulations and tabletop exercises.
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Affiliation(s)
- Evanson Z Sambala
- Cochrane South Africa, South African Medical Research Council, Box 19070, Cape Town, PO, 7505, South Africa.
| | - Tiwonge Kanyenda
- Vaccines for Africa Initiative, Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Chinwe Juliana Iwu
- Cochrane South Africa, South African Medical Research Council, Box 19070, Cape Town, PO, 7505, South Africa.,Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Chidozie Declan Iwu
- Department of Biochemistry and Microbiology, University of Fort Hare, Alice, South Africa
| | - Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Box 19070, Cape Town, PO, 7505, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Box 19070, Cape Town, PO, 7505, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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12
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Kater-Kuipers A, Bunnik EM, de Beaufort ID, Galjaard RJH. Limits to the scope of non-invasive prenatal testing (NIPT): an analysis of the international ethical framework for prenatal screening and an interview study with Dutch professionals. BMC Pregnancy Childbirth 2018; 18:409. [PMID: 30340550 PMCID: PMC6194707 DOI: 10.1186/s12884-018-2050-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/10/2018] [Indexed: 12/21/2022] Open
Abstract
Background The introduction of non-invasive prenatal testing (NIPT) for foetal aneuploidies is currently changing the field of prenatal screening in many countries. As it is non-invasive, safe and accurate, this technique allows for a broad implementation of first-trimester prenatal screening, which raises ethical issues, related, for instance, to informed choice and adverse societal consequences. This article offers an account of a leading international ethical framework for prenatal screening, examines how this framework is used by professionals working in the field of NIPT, and presents ethical guidance for the expansion of the scope of prenatal screening in practice. Methods A comparative analysis of authoritative documents is combined with 15 semi-structured interviews with professionals in the field of prenatal screening in the Netherlands. Data were recorded, transcribed verbatim and analysed using thematic analysis. Results The current ethical framework consists of four pillars: the aim of screening, the proportionality of the test, justice, and societal aspects. Respondents recognised and supported this framework in practice, but expressed some concerns. Professionals felt that pregnant women do not always make informed choices, while this is seen as central to reproductive autonomy (the aim of screening), and that pre-test counselling practices stand in need of improvement. Respondents believed that the benefits of NIPT, and of an expansion of its scope, outweigh the harms (proportionality), which are thought to be acceptable. They felt that the out-of-pocket financial contribution currently required by pregnant women constitutes a barrier to access to NIPT, which disproportionally affects those of a lower socioeconomic status (justice). Finally, professionals recognised but did not share concerns about a rising pressure to test or discrimination of disabled persons (societal aspects). Conclusions Four types of limits to the scope of NIPT are proposed: NIPT should generate only test outcomes that are relevant to reproductive decision-making, informed choice should be (made) possible through adequate pre-test counselling, the rights of future children should be respected, and equal access should be guaranteed. Although the focus of the interview study is on the Dutch healthcare setting, insights and conclusions can be applied internationally and to other healthcare systems.
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Affiliation(s)
- A Kater-Kuipers
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Room 24.17, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - E M Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Room 24.17, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - I D de Beaufort
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Room 24.17, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - R J H Galjaard
- Department of Clinical Genetics, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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13
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Blades CA, Stritzke WGK, Page AC, Brown JD. The benefits and risks of asking research participants about suicide: A meta-analysis of the impact of exposure to suicide-related content. Clin Psychol Rev 2018; 64:1-12. [PMID: 30014862 DOI: 10.1016/j.cpr.2018.07.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/29/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
One obstacle potentially hindering research on suicide is the assumption that assessing suicide may make individuals more likely to engage in suicidal thoughts or behaviours; a concern expressed by ethics committees, researchers, and clinicians. However, decisions which are overly cautious and restrictive when approving research proposals will hinder important research in this area. The present aim was to conduct a meta-analysis to examine whether asking about suicide or exposure to suicide-related content in research studies led to changes in participants' levels of distress, suicidal ideation, or suicide attempts. A systematic search of peer-reviewed and unpublished literature from 2000 to 2017 identified 18 studies. Exposure to suicide-related content led to significant, albeit small, reductions in suicidal ideation (g = -0.13, p < .001) and a lower likelihood of engaging in suicidal behaviour (OR = 0.714, p < .05). The reduction in suicidal ideation was moderated by age such that adolescents showed nearly twice as large a reduction in suicidal ideation from pre- to post-exposure as adults did. Thus, evidence to date suggests that asking research participants about suicide does not increase risk, and may be associated with small benefits. Ethics review boards should calibrate their consideration of the risks associated with participation based on the available evidence and relative to the cost of depriving potential participants of any benefits that participation may offer.
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Affiliation(s)
- Caroline A Blades
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
| | - Werner G K Stritzke
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
| | - Andrew C Page
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
| | - Julia D Brown
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia.
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Bunnik EM, van Bodegom L, Pinxten W, de Beaufort ID, Vernooij MW. Ethical framework for the detection, management and communication of incidental findings in imaging studies, building on an interview study of researchers' practices and perspectives. BMC Med Ethics 2017; 18:10. [PMID: 28166795 PMCID: PMC5294804 DOI: 10.1186/s12910-017-0168-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/19/2017] [Indexed: 12/25/2022] Open
Abstract
Background As thousands of healthy research participants are being included in small and large imaging studies, it is essential that dilemmas raised by the detection of incidental findings are adequately handled. Current ethical guidance indicates that pathways for dealing with incidental findings should be in place, but does not specify what such pathways should look like. Building on an interview study of researchers’ practices and perspectives, we identified key considerations for the set-up of pathways for the detection, management and communication of incidental findings in imaging research. Methods We conducted an interview study with a purposive sample of researchers (n = 20) at research facilities across the Netherlands. Based on a qualitative analysis of these interviews and on existing guidelines found in the literature, we developed a prototype ethical framework, which was critically assessed and fine-tuned during a two-day international expert meeting with bioethicists and representatives from large population-based imaging studies from the United Kingdom, Germany, Sweden and Belgium (n = 14). Results Practices and policies for the handling of incidental findings vary strongly across the Netherlands, ranging from no review of research scans and limited feedback to research participants, to routine review of scans and the arrangement of clinical follow-up. Respondents felt that researchers do not have a duty to actively look for incidental findings, but they do have a duty to act on findings, when detected. The principle of reciprocity featured prominently in our interviews and expert meeting. Conclusion We present an ethical framework that may guide researchers and research ethics committees in the design and/or evaluation of appropriate pathways for the handling of incidental findings in imaging studies. The framework consists of seven steps: anticipation of findings, information provision and informed consent, scan acquisition, review of scans, consultation on detected abnormalities, communication of the finding, and further clinical management and follow-up of the research participant. Each of these steps represents a key decision to be made by researchers, which should be justified not only with reference to costs and/or logistical considerations, but also with reference to researchers’ moral obligations and the principle of reciprocity.
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Affiliation(s)
- Eline M Bunnik
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Lisa van Bodegom
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Wim Pinxten
- Department of Morphology, Hasselt University, Agoralaan Gebouw D, BE 3590, Diepenbeek, Belgium
| | - Inez D de Beaufort
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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Abstract
Introduction: This paper aims to raise awareness regarding ethical issues in the context of humanitarian action, and to offer a framework for systematically and effectively addressing such issues.
Methods: Several cases highlight ethical issues that humanitarian aid workers are confronted with at different levels over the course of their deployments. The first case discusses a situation at a macro-level concerning decisions being made at the headquarters of a humanitarian organization. The second case looks at meso-level issues that need to be solved at a country or regional level. The third case proposes an ethical dilemma at the micro-level of the individual patient-provider relationship.
Discussion: These real-life cases have been selected to illustrate the ethical dimension of conflicts within the context of humanitarian action that might remain unrecognized in everyday practice. In addition, we propose an ethical framework to assist humanitarian aid workers in their decision-making process. The framework draws on the principles and values that guide humanitarian action and public health ethics more generally. Beyond identifying substantive core values, the framework also includes a ten-step process modelled on tools used in the clinical setting that promotes a transparent and clear decision-making process and improves the monitoring and evaluation of aid interventions. Finally, we recommend organizational measures to implement the framework effectively.
Conclusion: This paper uses a combination of public health/clinical ethics concepts and practices and applies them to the decision-making challenges encountered in relief operations in the humanitarian aid context.
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Affiliation(s)
- Caroline Clarinval
- Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland; Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts, USA
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Farajkhoda T, Latifnejad Roudsari R, Abbasi M. An exploratory study to develop a practical ethical framework for reproductive health research. Iran J Reprod Med 2013; 11:31-8. [PMID: 24639690 PMCID: PMC3941377] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 04/02/2012] [Accepted: 05/30/2012] [Indexed: 10/24/2022]
Abstract
BACKGROUND Research in reproductive health (RH) has been located in the core of women's health research. Providing accurate information through conducting scientific and controlled research is essential, but increased number of research in the world especially in developing countries in RH area in order to introduce advanced technologies has been resulted in much unethical, illegal and abusive research on women, which needs particular attention to ethical issues by the practitioners who are involved in RH research. OBJECTIVE This study was conducted to develop a practical ethical framework for RH research. MATERIALS AND METHODS 45 expert academics and clinicians in various disciplines included in a three rounds Delphi study through purposeful sampling method. In round 1 Delphi data were gathered using open-ended questions by e-mail and answers were analyzed by conventional content analysis and the findings merged and validated with the results of a thorough literature review. Face and content validity index were determined in round 2 Delphi and consensuses were attained in round 3. RESULTS Emerged categories were 1) management of the research process 2) protection of participants' rights 3) third party consent 4) gender sensitive research and 5) conflict of interest. CONCLUSION This study has provided a practical ethical framework according to the socio-cultural context of Iran for all practitioners who are involved in research on women. Adherence to this framework may protect practitioners against unethical and illegal lawsuits and help them to respect their clients' reproductive rights.
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Affiliation(s)
- Tahmineh Farajkhoda
- Department of Midwifery, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Robab Latifnejad Roudsari
- Department of Midwifery, School of Nursing and Midwifery, Patient Safety and Health Quality Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mahmoud Abbasi
- Shahid Beheshti Medical Law and Ethics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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