1
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Affleck P, Cons J, Kolstoe SE. Incision or insertion makes a medical intervention invasive. Commentary on 'What makes a medical intervention invasive?'. J Med Ethics 2024; 50:242-243. [PMID: 38159937 DOI: 10.1136/jme-2023-109733] [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] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Paul Affleck
- University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Julia Cons
- University of Nottingham, Nottingham, UK
| | - Simon E Kolstoe
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
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2
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Saylor KW, Joffe S. Enhancing social value considerations in prioritising publicly funded biomedical research: the vital role of peer review. J Med Ethics 2024; 50:253-257. [PMID: 37225413 DOI: 10.1136/jme-2022-108883] [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: 12/27/2022] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
The main goal of publicly funded biomedical research is to generate social value through the creation and application of knowledge that can improve the well-being of current and future people. Prioritising research with the greatest potential social value is crucial for good stewardship of limited public resources and ensuring ethical involvement of research participants. At the National Institutes of Health (NIH), peer reviewers hold the expertise and responsibility for social value assessment and resulting prioritisation at the project level. However, previous research has shown that peer reviewers place more emphasis on a study's methods ('Approach') than on its potential social value (best approximated by the criterion of 'Significance'). Lower weighting of Significance may be due to reviewers' views on the relative importance of social value, their belief that social value is evaluated at other stages of the research priority-setting process or the lack of guidance on how to approach the challenging task of assessing expected social value. The NIH is currently revising its review criteria and how these criteria contribute to overall scores. To elevate the role of social value in priority setting, the agency should support empirical research on how peer reviewers approach the assessment of social value, provide more specific guidance for reviewing social value and experiment with alternative reviewer assignment strategies. These recommendations would help ensure that funding priorities align with the NIH's mission and the obligation of taxpayer-funded research to contribute to the public good.
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Affiliation(s)
- Katherine W Saylor
- Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven Joffe
- Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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3
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Torrance RJ, Mormina M, Sayeed S, Kessel A, Yoon CH, Cislaghi B. Is the UN receiving ethical approval for its research with human participants? J Med Ethics 2024:jme-2023-109146. [PMID: 38413189 DOI: 10.1136/jme-2023-109146] [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] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
This paper examines the institutional mechanisms supporting the ethical oversight of human participant research conducted by the United Nations (UN). The UN has served an instrumental role in shaping international standards on research ethics, which invariably require ethical oversight of all research studies with human participants. The authors' experiences of conducting research collaboratively with UN agencies, in contrast, have led to concern that the UN frequently sponsors, or participates in, studies with human participants that have not received appropriate ethical oversight. It is argued that the institutional mechanisms in place to prevent research with human participants from being undertaken by the UN without ethical oversight do not, at present, extend substantively beyond the provision of guidelines and online training offered by a minority of UN bodies. The WHO and UNICEF are identified as notable exceptions, having implemented various measures to prevent health research with human participants from being undertaken without ethical oversight. Yet, it is highlighted that the WHO and UNICEF are not the only UN bodies that undertake health research with human participants and there are countless actors under the umbrella of the UN system that are regularly involved in non-health research with human participants. Arguments for the pursuit of the highest standard of ethical oversight by UN bodies are presented. Moving forward, the paper asks the question: is it time for the UN to set the standards for the oversight of ethical oversight?
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Affiliation(s)
- Robert James Torrance
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Maru Mormina
- African Centre of Epistemology and Philosophy of Science, University of Johannesburg, Johannesburg, South Africa
| | - Sadath Sayeed
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Anthony Kessel
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | | | - Beniamino Cislaghi
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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4
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Evans NG, Pence CH. Gain-of-function research and model organisms in biology. J Med Ethics 2024; 50:201-206. [PMID: 37188506 DOI: 10.1136/jme-2022-108853] [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: 12/15/2022] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
So-called 'gain-of-function' (GOF) research is virological research that results in a virus substantially more virulent or transmissible than its wild antecedent. GOF research has been subject to ethical analysis in the past, but the methods of GOF research have to date been underexamined by philosophers in these analyses. Here, we examine the typical animal used in influenza GOF experiments, the ferret, and show how despite its longstanding use, it does not easily satisfy the desirable criteria for an animal model We then discuss the limitations of the ferret model, and how those epistemic limitations bear on ethical and policy questions around the risks and benefits of GOF research. We conclude with a reflection on how philosophy of science can contribute to ethical and policy debates around the risks, benefits and relative priority of life sciences research.
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Affiliation(s)
- Nicholas G Evans
- Department of Philosophy, University of Massachussetts Lowell, Lowell, MA, USA
| | - Charles H Pence
- Institut supérieur de philosophie, Universite catholique de Louvain, Louvain-la-Neuve, Belgium
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5
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Lerner A, Eyal N. Future pandemics and the urge to 'do something'. J Med Ethics 2024:jme-2023-109791. [PMID: 38286591 DOI: 10.1136/jme-2023-109791] [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] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024]
Abstract
Research with enhanced potential pandemic pathogens (ePPP) makes pathogens substantially more lethal, communicable, immunosuppressive or otherwise capable of triggering a pandemic. We briefly relay an existing argument that the benefits of ePPP research do not outweigh its risks and then consider why proponents of these arguments continue to confidently endorse them. We argue that these endorsements may well be the product of common cognitive biases-in which case they would provide no challenge to the argument against ePPP research. If the case against ePPP research is strong, the views of professional experts do little to move the needle in favour of ePPP research.
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Affiliation(s)
- Adam Lerner
- Center for Population-Level Bioethics, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Nir Eyal
- Center for Population-Level Bioethics, Department of Philosophy (SAS) and Department of HBSP (SPH), Rutgers University, New Brunswick, New Jersey, USA
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6
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Schultz B, Agamah FE, Ewuoso C, Madden EB, Troyer J, Skelton M, Mwaka E. Webinar report: stakeholder perspectives on informed consent for the use of genomic data by commercial entities. J Med Ethics 2023; 50:57-61. [PMID: 36941048 PMCID: PMC10804035 DOI: 10.1136/jme-2022-108650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
In July 2020, the H3Africa Ethics and Community Engagement (E&CE) Working Group organised a webinar with ethics committee members and biomedical researchers from various African institutions throughout the Continent to discuss the issue of whether and how biological samples for scientific research may be accessed by commercial entities when broad consents obtained for the samples are silent. 128 people including Research Ethics Committee members (10), H3Africa researchers (46) including members of the E&CE working group, biomedical researchers not associated with H3Africa (27), representatives from the National Institutes of Health (16) and 10 other participants attended the webinar and shared their views. Several major themes emerged during the webinar, with the topics of broad versus explicit informed consent, defining commercial use, legacy samples and benefit sharing prevailing in the discussion. This report describes the consensus concerns and recommendations raised during the meeting and will be informative for future research on ethical considerations for genomic research in the African research context.
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Affiliation(s)
- Baergen Schultz
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Francis E Agamah
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Cornelius Ewuoso
- Medicine, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Ebony B Madden
- Training, Diversity and Health Equity Office, Office of the Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Troyer
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michelle Skelton
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Erisa Mwaka
- College of Health Sciences, Makerere University, Kampala, Uganda
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7
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Zhang TR. Ethics of 'Counting Me In': framing the implications of direct-to-patient genomics research. J Med Ethics 2023; 50:45-49. [PMID: 37130755 DOI: 10.1136/jme-2022-108741] [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: 11/07/2022] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
Count Me In (CMI) was launched in 2015 as a patient-driven research initiative aimed at accelerating the study of cancer genomics through direct participant engagement, electronic consent and open-access data sharing. It is an example of a large-scale direct-to-patient (DTP) research project which has since enrolled thousands of individuals. Within the broad scope of 'citizen science', DTP genomics research is defined here as a specific form of 'top-down' research endeavour developed and overseen by institutions within the traditional human subjects research context; in novel ways, it engages and recruits patients with defined diseases, consents them for medical information and biospecimens sharing, and stores and disseminates genomic information. Importantly, these projects simultaneously aim to empower participants in the research process while increasing sample size, particularly in rare disease states. Using CMI as a case study, this paper discusses how DTP genomics research raises new questions in the context of traditional human subjects research ethics, including issues surrounding participant selection, remote consent, privacy and return of results. It aims to demonstrate how current research ethics frameworks may be insufficient in this context, and that institutions, institutional review boards and investigators should be aware of these gaps and their role in ensuring the conduct of ethical, novel forms of research together with participants. Ultimately, a broader question is raised of whether the rhetoric of participatory genomics research advocates for an ethic of personal and social duty for contributing to the advancement of generalisable knowledge about health and disease.
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Affiliation(s)
- Tenny R Zhang
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, USA
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8
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Schaefer GO. If it walks like a duck…: Monitored Emergency Use of Unregistered and Experimental Interventions (MEURI) is research. J Med Ethics 2023:jme-2023-109169. [PMID: 38050144 DOI: 10.1136/jme-2023-109169] [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] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023]
Abstract
Monitored Emergency Use of Unregistered and Experimental Interventions (MEURI) is an ethical framework developed by the WHO for using unproven interventions in public health emergencies outside the context of medical research. It is mainly intended for use when medical research would be impracticable, but there is still a need to systematically gather data about unproven interventions. As such, it is designed as something of a middle ground between clinical and research ethical frameworks.However, I argue that MEURI does not truly lie at the intersection of clinical care and research. Due to its intent, structure and oversight requirements, it takes on most of the crucial features of research, to the point that it is best understood as a form of research. As a result, cases where MEURI could practicably be applied should instead make use of existing research frameworks. For those circumstances where research is truly impracticable, a more straightforward oversight system than MEURI is needed. While existing practices of compassionate use have some applicability, proposals to make use of clinical ethics committees to oversee unproven interventions may help achieve the right balance in acting in a patient's best interests when the relevant evidence base is weak.
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Affiliation(s)
- G Owen Schaefer
- Centre for Biomedical Ethics, National University Singapore Yong Loo Lin School of Medicine, Singapore
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9
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O'Neill J, Docherty Stewart B, Ng A, Roy Y, Yousif L, McIntyre KR. Medical student attitudes to patient involvement in healthcare decision-making and research. J Med Ethics 2023:jme-2023-109451. [PMID: 37989572 DOI: 10.1136/jme-2023-109451] [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] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Patient involvement is used to describe the inclusion of patients as active participants in healthcare decision-making and research. This study aimed to investigate incoming year 1 medical (MBChB) students' attitudes and opinions regarding patient involvement in this context. METHODS We established a staff-student partnership to formulate the design of an online research survey, which included Likert scale questions and three short vignette scenarios designed to probe student attitudes towards patient involvement linked to existing legal precedent. Incoming year 1 medical students (n=333) were invited to participate in the survey before formal teaching commenced. RESULTS Survey data (49 participants) indicate that students were broadly familiar with, and supportive of, patient involvement in medical treatment. There was least support for patient involvement in conducting (23.9%), contributing to (37.0%) or communicating research (32.6%), whereas there was unanimous support for patients choosing treatment from a selection of options (100%). CONCLUSION Incoming members of the medical profession demonstrate awareness of the need to actively involve patients in healthcare decision-making but are unfamiliar with the utility and value of such involvement in research. Further empirical studies are required to examine attitudes to patient involvement in healthcare.
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Affiliation(s)
- Jennifer O'Neill
- Lecturer, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Bronwyn Docherty Stewart
- Undergraduate Medical Student, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Anna Ng
- Undergraduate Medical Student, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Yamini Roy
- Undergraduate Medical Student, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Liena Yousif
- Undergraduate Medical Student, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Kirsty R McIntyre
- Lecturer, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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10
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Kostick-Quenet K, Lang BH, Smith J, Hurley M, Blumenthal-Barby J. Trust criteria for artificial intelligence in health: normative and epistemic considerations. J Med Ethics 2023:jme-2023-109338. [PMID: 37979976 DOI: 10.1136/jme-2023-109338] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/02/2023] [Indexed: 11/20/2023]
Abstract
Rapid advancements in artificial intelligence and machine learning (AI/ML) in healthcare raise pressing questions about how much users should trust AI/ML systems, particularly for high stakes clinical decision-making. Ensuring that user trust is properly calibrated to a tool's computational capacities and limitations has both practical and ethical implications, given that overtrust or undertrust can influence over-reliance or under-reliance on algorithmic tools, with significant implications for patient safety and health outcomes. It is, thus, important to better understand how variability in trust criteria across stakeholders, settings, tools and use cases may influence approaches to using AI/ML tools in real settings. As part of a 5-year, multi-institutional Agency for Health Care Research and Quality-funded study, we identify trust criteria for a survival prediction algorithm intended to support clinical decision-making for left ventricular assist device therapy, using semistructured interviews (n=40) with patients and physicians, analysed via thematic analysis. Findings suggest that physicians and patients share similar empirical considerations for trust, which were primarily epistemic in nature, focused on accuracy and validity of AI/ML estimates. Trust evaluations considered the nature, integrity and relevance of training data rather than the computational nature of algorithms themselves, suggesting a need to distinguish 'source' from 'functional' explainability. To a lesser extent, trust criteria were also relational (endorsement from others) and sometimes based on personal beliefs and experience. We discuss implications for promoting appropriate and responsible trust calibration for clinical decision-making use AI/ML.
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Affiliation(s)
- Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Benjamin H Lang
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
- Department of Philosophy, University of Oxford, Oxford, Oxfordshire, UK
| | - Jared Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Meghan Hurley
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
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11
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Resnik DB, Smith E. Should authorship on scientific publications be treated as a right? J Med Ethics 2023; 49:776-778. [PMID: 36878675 DOI: 10.1136/jme-2022-108874] [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] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Sometimes researchers explicitly or implicitly conceive of authorship in terms of moral or ethical rights to authorship when they are dealing with authorship issues. Because treating authorship as a right can encourage unethical behaviours, such as honorary and ghost authorship, buying and selling authorship, and unfair treatment of researchers, we recommend that researchers not conceive of authorship in this way but view it as a description about contributions to research. However, we acknowledge that the arguments we have given for this position are largely speculative and that more empirical research is needed to better ascertain the benefits and risks of treating authorship on scientific publications as a right.
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Affiliation(s)
- David B Resnik
- NIEHS, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Elise Smith
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Glaveston, Texas, USA
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12
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Raghunathan S. Returning research results to individuals who are incarcerated in the USA. J Med Ethics 2023:jme-2023-109493. [PMID: 37857508 DOI: 10.1136/jme-2023-109493] [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] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
The return of research results to populations and individuals is increasingly recognised as both important but ethically complicated. In the USA, there are few studies or detailed evidence-based practices on the return of research results to individuals who are incarcerated. In general, return of research results is not required with some exceptions; however, there are reasons to believe that in many cases returning results is most consistent with the ethical conduct of research. With individuals who are incarcerated, specific considerations for this historically disadvantaged population should be addressed. These are privacy, therapeutic misconception, paternalism, actionability and communication. If research results are returned, the initial consent process should consider thoroughness regarding privacy rights, the researchers' role, clarity around next steps and communication methods. Prison leadership should be key stakeholders in the process to streamline communication. Returning research results can be a method to counter historical and current paternalism in the carceral setting, while shifting the culture on how research is understood and conducted in carceral settings. The decision to return results should balance benefits, risks and research ethics. Further research is needed to identify and implement optimal approaches for returning results in this population.
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Affiliation(s)
- Sahana Raghunathan
- The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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13
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Galasso I, Geiger S. Genetic research and the collective good: participants as leaders to reconcile individual and public interests. J Med Ethics 2023:jme-2022-108867. [PMID: 37673669 DOI: 10.1136/jme-2022-108867] [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] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 08/12/2023] [Indexed: 09/08/2023]
Abstract
This paper problematises the notions of public or common good as weighed against individual sovereignty in the context of medical research by focusing on genetic research. We propose the notion of collective good as the good of the particular collective in which the research was conducted. We conducted documentary and interview-based research with participant representatives and research leaders concerned with participant involvement in leading genetic research projects and around two recent genetic data controversies: the case of the UK Wellcome Sanger Institute, accused of planning unauthorised commercialisation of African DNA samples, and the case of the company Genuity Science, which planned genetic research on brain tumour samples in Ireland with no explicit patient consent. We advocate for greater specificity in circumscribing the collective to which genetic research relates and for greater efforts in including representatives of this collective as research coleaders in order to enable a more inclusive framing of the good arising from such research. Such community-based participant cogovernance and coleadership in genetic research is vital especially when minorities or vulnerable groups are involved, and it centrally requires community capacity building to help collectives articulate their own notions of the collective good.
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Affiliation(s)
- Ilaria Galasso
- School of Business, UCD, Dublin, Ireland
- Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany
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14
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Graham M, Milne R, Fitzsimmons P, Sheehan M. TREs are still not about trust. J Med Ethics 2023; 49:658-660. [PMID: 36918262 DOI: 10.1136/jme-2023-109031] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Mackenzie Graham
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Richard Milne
- Wellcome Connecting Science, Wellcome Genome Campus, Hixton, UK
- Kavli Centre for Ethics, Science and the Public, Faculty of Education, University of Cambridge, Cambridge, UK
| | - Paige Fitzsimmons
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mark Sheehan
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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15
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Affleck P, Westaway J, Smith M, Schrecker G. Trusted research environments are definitely about trust. J Med Ethics 2023; 49:656-657. [PMID: 36323512 DOI: 10.1136/jme-2022-108678] [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: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
In their highly topical paper, Graham et al argued that Trusted Research Environments (TREs) are not actually about trust because they reduce or remove '…the need for trust in the use and sharing of patient health data'. We believe this is fundamentally mistaken. TREs mitigate or remove some risks, but they do not address all public concerns. In this regard, TREs provide evidence for people to decide whether the bodies holding and using their data can be trusted. TREs may make it easier for people to trust but there is still a need for that trust.
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Affiliation(s)
- Paul Affleck
- University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Jenny Westaway
- Independent Advisor in Public Policy and Citizen Engagement, Leeds, UK
| | | | - Geoff Schrecker
- Retired GP and Independent Consultant in Clinical Informatics, Derbyshire, UK
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16
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Piotrowska M. Diversity and inclusion for rodents: how animal ethics committees can help improve translation. J Med Ethics 2023:jme-2023-109166. [PMID: 37407026 DOI: 10.1136/jme-2023-109166] [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] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Abstract
Translation failure occurs when a treatment shown to be safe and effective in one type of population does not produce the same result in another. We are currently in a crisis involving the translatability of preclinical studies to human populations. Animal trials are no better than a coin toss at predicting the safety and efficacy of drugs in human trials, and the high failure rate of drugs entering human trials suggests that most of the suffering of laboratory animals is futile, creating no commensurate benefit for human patients. Here, I argue that animal ethics committees have a role to play in getting us out of this crisis. Inadequate representation is a known contributor to translation failures and is a matter of both scientific and ethical concern. Ethical review committees have the authority to address it by reprioritising the values already enshrined in their guiding principles.
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Affiliation(s)
- Monika Piotrowska
- Philosophy, University at Albany, State University of New York, Albany, New York, USA
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17
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Holm S, Lewis J, Dal-Ré R. Equipoise, standard of care and consent: responding to the authorisation of new COVID-19 treatments in randomised controlled trials. J Med Ethics 2023; 49:465-470. [PMID: 35606010 PMCID: PMC9157327 DOI: 10.1136/medethics-2022-108182] [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: 01/28/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of molnupiravir, a novel antiviral medicine aimed at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of molnupiravir through the large-scale Platform Adaptive trial of Novel antiviRals for eArly treatMent of COVID-19 In the Community randomised control trial. By analysing the ways in which the authorisation and clinical use of molnupiravir complicate standard approaches to clinical equipoise, standard of care and participant consent in the PANORAMIC randomised control trial, we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers.
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Affiliation(s)
- Soren Holm
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, Manchester, UK
- HELSAM, Center for Medical Ethics, University of Oslo Faculty of Medicine, Oslo, Oslo, Norway
| | - Jonathan Lewis
- Centre for Social Ethics and Policy, The University of Manchester, Manchester, Manchester, UK
| | - Rafael Dal-Ré
- Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autonoma de Madrid, Madrid, Spain
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Lyle K, Weller S, Samuel G, Lucassen AM. Beyond regulatory approaches to ethics: making space for ethical preparedness in healthcare research. J Med Ethics 2023; 49:352-356. [PMID: 35725300 PMCID: PMC10176337 DOI: 10.1136/medethics-2021-108102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/23/2022] [Indexed: 05/14/2023]
Abstract
Centralised, compliance-focused approaches to research ethics have been normalised in practice. In this paper, we argue that the dominance of such systems has been driven by neoliberal approaches to governance, where the focus on controlling and individualising risk has led to an overemphasis of decontextualised ethical principles and the conflation of ethical requirements with the documentation of 'informed consent'. Using a UK-based case study, involving a point-of-care-genetic test as an illustration, we argue that rather than ensuring ethical practice such compliance-focused approaches may obstruct valuable research. We call for an approach that encourages researchers and research communities-including regulators, ethics committees, funders and publishers of academic research-to acquire skills to make morally appropriate decisions, and not base decision-making solely on compliance with prescriptive regulations. We call this 'ethical preparedness' and outline how a research ethics system might make space for this approach.
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Affiliation(s)
- Kate Lyle
- Clinical Ethics, Law and Society (CELS), Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Clinical Ethics, Law and Society (CELS), Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
| | - Susie Weller
- Clinical Ethics, Law and Society (CELS), Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Clinical Ethics, Law and Society (CELS), Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
| | - Gabby Samuel
- Clinical Ethics, Law and Society (CELS), Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Global Health and Social Medicine, King's College London, Strand, UK
| | - Anneke M Lucassen
- Clinical Ethics, Law and Society (CELS), Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Clinical Ethics, Law and Society (CELS), Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, UK
- Centre for Personalised Medicine, University of Oxford, Oxford, UK
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Cavolo A, Gastmans C. Assent: going beyond acknowledgement for fair inclusion. J Med Ethics 2023:jme-2023-108969. [PMID: 37045592 DOI: 10.1136/jme-2023-108969] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/06/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Alice Cavolo
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Chris Gastmans
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
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Lewis J, Holm S. What should recognition entail? Responding to the reification of autonomy and vulnerability in medical research. J Med Ethics 2023:jme-2023-109003. [PMID: 37045594 DOI: 10.1136/jme-2023-109003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/06/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Jonathan Lewis
- Centre for Social Ethics and Policy, Department of Law, The University of Manchester, Manchester, UK
| | - Soren Holm
- Centre for Social Ethics and Policy, Department of Law, The University of Manchester, Manchester, UK
- Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
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21
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Soofi H. Assent to research by the formerly competent: necessary and sufficient? J Med Ethics 2023:jme-2023-109008. [PMID: 37045593 DOI: 10.1136/jme-2023-109008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/06/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Hojjat Soofi
- Sydney Health Ethics, The University of Sydney, Sydney, New South Wales, Australia
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Schofield G, Baker I. Expanded terminal sedation: too removed from real-world practice. J Med Ethics 2023; 49:267-268. [PMID: 36813550 DOI: 10.1136/jme-2023-109016] [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] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Guy Schofield
- Department of Oncology and Palliative Medicine, Imperial College Healthcare NHS Trust, London, UK
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
| | - Idris Baker
- Department of Palliative Medicine, Swansea Bay University Health Board, Port Talbot, UK
- Swansea University Medical School, Swansea, UK
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Sorum PC, Pratt DS. Implications of extended terminal sedation. J Med Ethics 2023; 49:265-266. [PMID: 36854626 DOI: 10.1136/jme-2023-109019] [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] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Paul Clay Sorum
- Departments of Medicine and Pediatrics, Albany Medical College, Cohoes, New York, USA
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Riisfeldt TD. Expanded terminal sedation: dangerous waters. J Med Ethics 2023; 49:261-262. [PMID: 36894308 DOI: 10.1136/jme-2023-109021] [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] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Thomas David Riisfeldt
- Department of Philosophy, University of New South Wales, Sydney, New South Wales, Australia
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Frith L, McMillan J. Broadening the debate: the future of JME feature articles. J Med Ethics 2023; 49:155. [PMID: 36810153 DOI: 10.1136/jme-2023-108936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Lucy Frith
- Centre for Social Ethics & Policy, The University of Manchester, Manchester, UK
| | - John McMillan
- Bioethics Centre, University of Otago, Dunedin, New Zealand
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Affiliation(s)
- Hazem Zohny
- Bioethics Centre, The University of Otago, Dunedin, New Zealand
| | - John McMillan
- Bioethics Centre, The University of Otago, Dunedin, New Zealand
| | - Mike King
- Bioethics Centre, The University of Otago, Dunedin, New Zealand
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Smajdor A. Reification and assent in research involving those who lack capacity. J Med Ethics 2023:jme-2022-108710. [PMID: 36690468 DOI: 10.1136/jme-2022-108710] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
In applied ethics, and in medical treatment and research, the question of how we should treat others is a central problem. In this paper, I address the ethical role of assent in research involving human beings who lack capacity. I start by thinking about why consent is ethically important, and consider what happens when consent is not possible. Drawing on the work of the German philosopher Honneth, I discuss the concept of reification-a phenomenon that manifests itself when we fail to observe or respond to our fellow humans' need for recognition. I suggest that assent is a way of responding to this moral need for recognition, which exists independently of cognitive capacity. I will look at the circumstances in which consent cannot be obtained from human beings, and ask whether some of the same ethically important considerations that underpin the need for consent might be achieved through seeking assent. I discuss the ways in which this might be beneficial for researchers, for prospective research participants and for society at large.
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Hutchins GPJ, Stone VE, Hall KT. Open notes: Unintended consequences and teachable moments. J Med Ethics 2022; 49:jme-2022-108765. [PMID: 36460422 DOI: 10.1136/jme-2022-108765] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Affiliation(s)
- George Patrick Joseph Hutchins
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Sociology, Harvard University, Cambridge, Massachusetts, USA
| | - Valerie E Stone
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kathryn T Hall
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Boston Public Health Commission, Boston, Massachusetts, USA
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29
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Barclay L. Flourishing is not a conception of dignity. J Med Ethics 2022; 48:975-976. [PMID: 36384893 DOI: 10.1136/jme-2022-108721] [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] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Linda Barclay
- Philosophy, Monash University, Clayton, Victoria, Australia
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Formosa P. Care for well-being or respect for dignity? A commentary on Soofi's 'what moral work can Nussbaum's account of human dignity do in the context of dementia care?'. J Med Ethics 2022; 48:970-971. [PMID: 36376094 DOI: 10.1136/jme-2022-108725] [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] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Paul Formosa
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
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Killmister S. Supplementing the capabilities approach. J Med Ethics 2022; 48:977-978. [PMID: 36442971 DOI: 10.1136/jme-2022-108726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
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Kok N, Zegers M, van der Hoeven H, Hoedemaekers C, van Gurp J. Morisprudence: a theoretical framework for studying the relationship linking moral case deliberation, organisational learning and quality improvement. J Med Ethics 2022; 48:medethics-2021-107943. [PMID: 35584897 DOI: 10.1136/medethics-2021-107943] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
There is a claim that clinical ethics support services (CESS) improve healthcare quality within healthcare organisations. However, there is lack of strong evidence supporting this claim. Rather, the current focus is on the quality of CESS themselves or on individual learning outcomes. In response, this article proposes a theoretical framework leading to empirical hypotheses that describe the relationship between a specific type of CESS, moral case deliberation and the quality of care at the organisational level. We combine insights from the literature on CESS, organisational learning and quality improvement and argue that moral case deliberation causes healthcare professionals to acquire practical wisdom. At the organisational level, where improving quality is a continuous and collective endeavour, this practical wisdom can be aggregated into morisprudence, which is an ongoing formulation of moral judgements across cases encountered within the organisation. Focusing on the development of morisprudence enables refined scrutinisation of CESS-related quality claims.
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Affiliation(s)
- Niek Kok
- IQ healthcare, Radboudumc, Nijmegen, The Netherlands
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Affiliation(s)
- Brian D Earp
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, England
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