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Levinson AH, Crepeau-Hobson MF, Coors ME, Glover JJ, Goldberg DS, Wynia MK. Duties When an Anonymous Student Health Survey Finds a Hot Spot of Suicidality. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:50-60. [PMID: 32945754 DOI: 10.1080/15265161.2020.1806374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that included school-level analysis discovered a school with alarmingly prevalent student suicidality. Given confidentiality protocols typical of surveillance, the surveyors were uncertain whether and how to intervene. We searched literature for duties to warn at-risk groups discovered during public health surveillance, but we found no directly applicable guidance or cases. Reasoning by analogy, we conclude that surveyors should contact the school's leaders to call attention to its outlier status, but public warning is unwarranted. However, such an ad hoc decision to issue a warning, even if only to school leaders, raises significant practical, legal and ethical issues. National public health and education associations should produce guidance that clarifies ethical and legal duties owed to schools and students involved in population health-risk surveillance.
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Affiliation(s)
- Arnold H Levinson
- University of Colorado | Anschutz Medical Campus
- Colorado School of Public Health
| | | | - Marilyn E Coors
- University of Colorado | Anschutz Medical Campus
- Center for Bioethics and Humanities
| | - Jacqueline J Glover
- University of Colorado | Anschutz Medical Campus
- Center for Bioethics and Humanities
| | - Daniel S Goldberg
- University of Colorado | Anschutz Medical Campus
- Center for Bioethics and Humanities
| | - Matthew K Wynia
- University of Colorado | Anschutz Medical Campus
- Center for Bioethics and Humanities
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2
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Wilkins CH, Mapes BM, Jerome RN, Villalta-Gil V, Pulley JM, Harris PA. Understanding What Information Is Valued By Research Participants, And Why. Health Aff (Millwood) 2020; 38:399-407. [PMID: 30830824 DOI: 10.1377/hlthaff.2018.05046] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is growing public demand that research participants receive all of their results, regardless of whether clinical action is indicated. Instead of the standard practice of returning only actionable results, we propose a reconceptualization called "return of value" to encompass the varied ways in which research participants value specific results and more general information they receive beyond actionable results. Our proposal is supported by a national survey of a diverse sample, which found that receiving research results would be valuable to most (78.5 percent) and would make them more likely to trust researchers (70.3 percent). Respondents highly valued results revealing genetic effects on medication response and predicting disease risk, as well as information about nearby clinical trials and updates on how their data were used. The information most valued varied by education, race/ethnicity, and age. Policies are needed to enable return of information in ways that recognize participants' differing informational needs and values.
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Affiliation(s)
- Consuelo H Wilkins
- Consuelo H. Wilkins ( ) is the vice president for health equity, Vanderbilt University Medical Center, and an associate professor in the Department of Medicine, Vanderbilt University Medical Center, and the Department of Internal Medicine, Meharry Medical College, all in Nashville, Tennessee
| | - Brandy M Mapes
- Brandy M. Mapes is a senior project manager in the Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center
| | - Rebecca N Jerome
- Rebecca N. Jerome is a manager of translational research in the Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center
| | - Victoria Villalta-Gil
- Victoria Villalta-Gil is a senior research specialist in the Meharry Vanderbilt Alliance
| | - Jill M Pulley
- Jill M. Pulley is executive director of the Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center
| | - Paul A Harris
- Paul A. Harris is director of the Office of Research Informatics in the Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center
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Best M, Butow P, Jacobs C, Juraskova I, Savard J, Meiser B, Goldstein D, Ballinger M, Bartley N, Napier C, Davies G, Thomas D, Tucker K, Schlub T, Newson AJ. Advanced cancer patient preferences for receiving molecular profiling results. Psychooncology 2020; 29:1533-1539. [PMID: 32544291 DOI: 10.1002/pon.5446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to discern preferences for receiving somatic molecular profiling (MP) results in cancer patients who have given consent to undergo testing. METHODS We conducted a mixed-methods study to explore patients' views on which MP results they would like to receive and why. Advanced cancer patients (n = 1299) completed questionnaires after giving consent to participate in a parent genomics study and undergoing MP. A subset of patients (n = 20) participated in qualitative interviews. RESULTS Almost all (96%) participants were interested in receiving results which would direct cancer treatment (ie, were actionable). A smaller majority wanted to access results which were not actionable (64%) or were variants of unknown significance (60%). Most (86%) were interested in finding out about germline findings, though not as a priority. Themes identified in interview data were: (a) Cancer is the focus; (b) Trust in clinicians; and (c) Respect for a right not to know. CONCLUSIONS The majority of advanced cancer patients undergoing MP prioritised results which would lead to treatment options. They trusted their oncologists to help them navigate the results return process. While there was interest in knowing about other results, this was a lesser priority. Nevertheless, given high levels of interest in receiving all results, ethical aspects of not providing uninformative results requires further research, including a consideration of patient rationales for desiring this information and what health professionals can and should do to support patients in the absence of meaningful information being available.
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Affiliation(s)
- Megan Best
- The University of Notre Dame, Sydney, NSW, 2007, Australia.,School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-Based Decision-Making, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Jacobs
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology & Evidence-Based Decision-Making, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital Cancer Services, Randwick, New South Wales, Australia
| | - Mandy Ballinger
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Nicci Bartley
- The University of Notre Dame, Sydney, NSW, 2007, Australia
| | - Christine Napier
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Grace Davies
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Thomas
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Kathy Tucker
- Hereditary Cancer Clinic, Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
| | - Timothy Schlub
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ainsley J Newson
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Wolf SM. Return of Results in Participant-Driven Research: Learning from Transformative Research Models. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:159-166. [PMID: 32342739 DOI: 10.1177/1073110520917042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Participant-driven research (PDR) is a burgeoning domain of research innovation, often facilitated by mobile technologies (mHealth). Return of results and data are common hallmarks, grounded in transparency and data democracy. PDR has much to teach traditional research about these practices and successful engagement. Recommendations calling for new state laws governing research with mHealth modalities common in PDR and federal creation of review mechanisms, threaten to stifle valuable participant-driven innovation, including in return of results.
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Affiliation(s)
- Susan M Wolf
- Susan M. Wolf, J.D., is McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; and Professor of Medicine at the University of Minnesota. She chairs the University's Consortium on Law and Values in Health, Environment & the Life Sciences
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Allyse M, Rust L. Assessing Duty to Warn in Donated Embryos. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:75-76. [PMID: 30040557 DOI: 10.1080/15265161.2018.1478038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Porter KM, Danis M, Taylor HA, Cho MK, Wilfond BS. The Emergence of Clinical Research Ethics Consultation: Insights From a National Collaborative. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:39-45. [PMID: 29313771 PMCID: PMC6188703 DOI: 10.1080/15265161.2017.1401156] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards (IRBs), to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation (REC) services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical commentaries to highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research.
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Wouters RHP, Bijlsma RM, Ausems MGEM, van Delden JJM, Voest EE, Bredenoord AL. Am I My Family's Keeper? Disclosure Dilemmas in Next-Generation Sequencing. Hum Mutat 2017; 37:1257-1262. [PMID: 27647774 DOI: 10.1002/humu.23118] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/11/2016] [Accepted: 09/12/2016] [Indexed: 01/18/2023]
Abstract
Ever since genetic testing is possible for specific mutations, ethical debate has sparked on the question of whether professionals have a duty to warn not only patients but also their relatives that might be at risk for hereditary diseases. As next-generation sequencing (NGS) swiftly finds its way into clinical practice, the question who is responsible for conveying unsolicited findings to family members becomes increasingly urgent. Traditionally, there is a strong emphasis on the duties of the professional in this debate. But what is the role of the patient and her family? In this article, we discuss the question of whose duty it is to convey relevant genetic risk information concerning hereditary diseases that can be cured or prevented to the relatives of patients undergoing NGS. We argue in favor of a shared responsibility for professionals and patients and present a strategy that reconciles these roles: a moral accountability nudge. Incorporated into informed consent and counseling services such as letters and online tools, this nudge aims to create awareness on specific patient responsibilities. Commitment of all parties is needed to ensure adequate dissemination of results in the NGS era.
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Affiliation(s)
- Roel H P Wouters
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rhodé M Bijlsma
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emile E Voest
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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8
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Boers SN, van Delden JJM, Knoers NV, Bredenoord AL. Postmortem disclosure of genetic information to family members: active or passive? Trends Mol Med 2016; 21:148-53. [PMID: 25743261 DOI: 10.1016/j.molmed.2015.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/22/2014] [Accepted: 01/07/2015] [Indexed: 01/19/2023]
Abstract
Advances in next-generation DNA sequencing (NGS) now make it possible, and affordable, to sequence the entire genome of an individual. Routine clinical application is on the horizon. There is a consensus that some subsets of genetic information should be disclosed to patients, but disclosure to their relatives is less consensual. This issue becomes especially salient after a patient's death, when permission can no longer be sought. There has however been little debate on postmortem disclosure. We identify and explain the arguments in favor of and against disclosure of genetic information to the relatives of a deceased patient. We conclude that there are valid reasons to communicate some subsets of genetic information to family members after death, and we propose a passive postmortem disclosure policy.
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Affiliation(s)
- Sarah N Boers
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Nine V Knoers
- Department of Medical Genetics, University Medical Center Utrecht, KC04.084.2, PO Box 85090, 3508 GA Utrecht, The Netherlands
| | - Annelien L Bredenoord
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Baughman ST, Morris E, Jensen K, Austin J. Disclosure of psychiatric manifestations of 22q11.2 deletion syndrome in medical genetics: A 12-year retrospective chart review. Am J Med Genet A 2015; 167A:2350-6. [PMID: 26033850 DOI: 10.1002/ajmg.a.37190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/15/2015] [Indexed: 01/16/2023]
Abstract
Individuals with 22q11.2 deletion syndrome (22qDS) have increased risk for psychiatric disorders. However, while medical geneticists self-report discussing psychiatric features of 22qDS with families (though often only when the child is older), most parents of children with 22qDS report receiving information about the psychiatric manifestations of 22qDS from non-medical sources. In an attempt to reconcile these previous findings, we sought to objectively determine the frequency with which medical geneticists discuss the potential psychiatric manifestations of 22qDS: (i) in letters to referring physicians and (ii) with families, and to explore plans for follow-up. We abstracted data from charts of patients with 22qDS who were referred to a single medical genetics center between January 1, 2000 and December 31, 2012. Psychiatric disorders were discussed in consult letters to referring physicians for n = 57 (46%) of the 125 patients who met inclusion criteria-making them less frequently discussed than all other features of 22qDS. Despite exhaustive review of charts, the content of discussions with families was typically unclear. Follow-up in medical genetics was suggested for 50 people but only 18 (36%) of these patients returned. Disclosure of psychiatric features of 22qDS to families is necessary so that psychiatric disorders can be identified in time for early intervention to be implemented to achieve better prognosis for those affected. These empiric data offer some explanation as to why psychiatric services are underused by individuals with 22qDS.
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Affiliation(s)
- Serena Talcott Baughman
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Morris
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly Jensen
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jehannine Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Branum R, Wolf SM. International Policies on Sharing Genomic Research Results with Relatives: Approaches to Balancing Privacy with Access. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:576-93. [PMID: 26479568 PMCID: PMC4617202 DOI: 10.1111/jlme.12301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Returning genetic research results to relatives raises complex issues. In order to inform the U.S. debate, this paper analyzes international law and policies governing the sharing of genetic research results with relatives and identifies key themes and lessons. The laws and policies from other countries demonstrate a range of approaches to balancing individual privacy and autonomy with family access for health benefit, offering important lessons for further development of approaches in the United States.
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Affiliation(s)
- Rebecca Branum
- Policy director at the Minnesota State College Student Association and previously served as a Research Associate at the University of Minnesota's Consortium on Law and Values in Health, Environment & the Life Sciences
| | - Susan M Wolf
- McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; Professor of Medicine; Faculty member, Center for Bioethics; and Chair, Consortium on Law and Values in Health, Environment & the Life Sciences at the University of Minnesota. She is one of three Principal Investigators on NIH/NCI/NHGRI grant 1-R01-CA154517 on return of genomic results to family members, including after the death of the proband
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11
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Wolf SM, Branum R, Koenig BA, Petersen GM, Berry SA, Beskow LM, Daly MB, Fernandez CV, Green RC, LeRoy BS, Lindor NM, O'Rourke PP, Breitkopf CR, Rothstein MA, Van Ness B, Wilfond BS. Returning a Research Participant's Genomic Results to Relatives: Analysis and Recommendations. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:440-63. [PMID: 26479555 PMCID: PMC4617203 DOI: 10.1111/jlme.12288] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.
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Affiliation(s)
- Susan M Wolf
- McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; Professor of Medicine; Faculty member, Center for Bioethics; and Chair, Consortium on Law and Values in Health, Environment & the Life Sciences at the University of Minnesota. She is one of three Principal Investigators on NIH/NCI/NHGRI grant 1-R01-CA154517 on return of genomic results to family members, including after the death of the proband
| | - Rebecca Branum
- Policy director at the Minnesota State College Student Association and previously served as a Research Associate at the University of Minnesota's Consortium on Law and Values in Health, Environment & the Life Sciences
| | - Barbara A Koenig
- Professor of Bioethics and Medical Anthropology based at the Institute for Health & Aging, University of California, San Francisco. Currently, she co-directs a Center of Excellence in ELSI Research focused on translational genomics, co-leads an NCI/NHGRI R01 on return of results in genomic biobanks, and directs the ELSI component of a U19 award focused on newborn screening in an era of whole genome analysis
| | - Gloria M Petersen
- Professor of Epidemiology in the Department of Health Sciences Research at Mayo Clinic College of Medicine in Rochester, Minnesota. She earned her Master's degree in Anthropology from University of Oregon, and Ph.D. in Anthropology from UCLA. She is a Founding Fellow of the American College of Medical Genetics and Genomics
| | - Susan A Berry
- Professor of Pediatrics & Genetics and Division Director for Genetics and Metabolism in the Department of Pediatrics, University of Minnesota. She is a member of the Minnesota Department of Health Newborn Screening Advisory Committee, the Society for Inherited Metabolic Disease, and the American Society of Human Genetics, and is a Fellow of the American Academy of Pediatrics and the American College of Medical Genetics
| | - Laura M Beskow
- Associate Professor at the Duke University School of Medicine and Duke Clinical Research Institute, where her work focuses on ethics and policy issues in biomedical research - particularly human subjects issues in large-scale genomic and translational research. She holds a B.S. in nutrition from Iowa State University, an M.P.H. with a concentration in health law from Boston University, and a Ph.D. in health policy and administration from the University of North Carolina at Chapel Hill
| | - Mary B Daly
- Medical oncologist and epidemiologist who chairs the Department of Clinical Genetics at Fox Chase Cancer Center. Her research focuses on defining the best methods of communicating hereditary cancer risk information and on providing risk management strategies and coping skills to family members dealing with an increased risk for cancer
| | - Conrad V Fernandez
- Professor and Head of the Division of Pediatric Hematology/Oncology in the Department of Pediatrics, IWK Health Centre, Dalhousie University and is cross-appointed in Bioethics, Medicine, and Postgraduate Studies. He obtained his Hon. B.Sc. at the University of Western Ontario, his medical degree at McMaster University, specialist certification in Pediatrics as a Fellow of the Royal College of Physicians and Surgeons of Canada at Dalhousie University, and completed specialty training in Pediatric Hematology/Oncology at the University of British Columbia
| | - Robert C Green
- Medical geneticist and physician-scientist who directs the G2P Research Program in translational genomics and health outcomes in the Division of Genetics, Brigham and Women's Hospital and Harvard Medical School. He is also Associate Director for Research at Partners Personalized Medicine. Dr. Green leads and co-leads the MedSeq Project and the BabySeq Project respectively, two NIH-funded randomized trials designed to explore the medical, behavioral, and economic implications of integrating genome sequencing into the medical care of adults and newborns
| | - Bonnie S LeRoy
- Professor and Director of the Graduate Program in Genetic Counseling, University of Minnesota. The primary focus of her work is on preparing graduate students to enter the profession of genetic counseling. Her research examines the ethical and social challenges associated with the genetic counseling profession. Prof. LeRoy served as the President of the American Board of Genetic Counseling from 2001-03
| | - Noralane M Lindor
- Professor of Medical Genetics in the Department of Health Sciences Research at Mayo Clinic in Scottsdale, Arizona. She received her Bachelor of Arts degree from the University of Minnesota, her doctorate of medicine from Mayo Medical School in Rochester, Minnesota, and did her residencies at Bowman Gray School of Medicine in Winston-Salem, North Carolina, and at Mayo Clinic in Rochester
| | - P Pearl O'Rourke
- Director of Human Research Affairs at Partners HealthCare in Boston, and Associate Professor of Pediatrics at Harvard Medical School. She received her B.A. from Yale University, and completed medical school at Dartmouth Medical School and the University of Minnesota Medical School
| | - Carmen Radecki Breitkopf
- Associate Professor of Health Services Research in the Department of Health Sciences Research at Mayo Clinic College of Medicine in Rochester, Minnesota. She earned her Master's and Doctoral degrees in Psychology from the State University of New York at Albany
| | - Mark A Rothstein
- Herbert F. Boehl Chair of Law & Medicine and Director of the Institute for Bioethics, Health Policy & Law, University of Louisville School of Medicine. From 1999-2008, he served as Chair of the Subcommittee on Privacy and Confidentiality of the National Committee on Vital and Health Statistics, the statutory advisory committee to the Secretary of Health and Human Services on health information policy. He is past-President of the American Society of Law, Medicine & Ethics and serves as Public Health Ethics editor for the American Journal of Public Health
| | - Brian Van Ness
- Professor of Genetics, Cell Biology and Development at the University of Minnesota. He earned his doctorate in Biochemistry from the University of Minnesota, completed a postdoctoral fellowship at Fox Chase Cancer Center in Philadelphia, and has served as the Department Head and Director of the Institute of Human Genetics at the University of Minnesota
| | - Benjamin S Wilfond
- Director of the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital; Professor and Chief of the Division of Bioethics; Professor, Pulmonary and Sleep Medicine, Department of Pediatrics; and Adjunct Professor, Department of Bioethics and Humanities, University of Washington School of Medicine. He is President of the Association of Bioethics Program Directors, Chair for the Clinical Research Ethics Consultation Working Group for the Clinical and Translational Science Awards program, and a member of the Bioethics and Legal Working Group of the Newborn Screening Translational Research Network
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Melvin AJ, Mohan KM, Wald A, Porter K, Wilfond BS. Research Recruitment of Adult Survivors of Neonatal Infections: Is There a Role for Parental Consent? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:58-9. [PMID: 26479109 PMCID: PMC4817491 DOI: 10.1080/15265161.2015.1075798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Research on competent adult subjects does not require the consent of anyone beyond that of the adult subject. This case is complicated, however, because the targeted subjects were initially enrolled by their parents in a neonatal study and because the focus of the study, genital herpes simplex virus (HSV), carries significant stigma in the community. In considering the ethical issue of directly approaching the young adults for participation in this research, there are three key themes that need to be evaluated and considered: 1) the importance of the research for anticipatory guidance about the long-term impact of neonatal HSV; 2) the concerns of parents in disclosing the diagnosis; and 3) the interests of affected teens/young adults and their future partners.
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Akpinar A, Ersoy N. Attitudes of physicians and patients towards disclosure of genetic information to spouse and first-degree relatives: a case study from Turkey. BMC Med Ethics 2014; 15:39. [PMID: 24885495 PMCID: PMC4029893 DOI: 10.1186/1472-6939-15-39] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 04/30/2014] [Indexed: 11/30/2022] Open
Abstract
Background When considering the principle of medical confidentiality, disclosure of genetic information constitutes a special case because of the impact that this information can have on the health and the lives of relatives. The aim of this study is to explore the attitudes of Turkish physicians and patients about sharing information obtained from genetic tests. Methods The study was carried out in Kocaeli, Turkey. Participants were either paediatricians and gynaecologists registered in Kocaeli, or patients coming to the genetic diagnosis centre for karyotype analysis in 2008. A self-administered paper questionnaire was given to the physicians, and face-to-face structured interviews were conducted with patients. We used a case study involving a man who was found to be a balanced chromosome carrier as a result of a test conducted after his first baby was born with Down's syndrome. However, he refused to share this information with his wife or his siblings. Percentages of characteristics and preferences of the participants were calculated, and the results were analysed using Kruskal-Wallis test. Results A total of 155 physicians (68% response rate) and 104 patients (46% response rate) were participated in the study. Twenty-six percent of physicians and 49% of patients believed that genetic information belongs to the whole family. When participants were asked with whom genetic information should be shared for the case study, most of the physicians and patients thought the physician should inform the spouse (79%, 85%, respectively). They were less likely to support a physician informing a sibling (41%, 53%, respectively); whereas, many thought the testee has an obligation to inform siblings (70%, 94%, respectively). Conclusions Although Turkey’s national regulations certainly protect the right of privacy of the testee, the participants in our study appear to believe that informing the spouse, who is not personally at risk of serious damage, is the physician’s responsibility, while informing siblings, is the testee’s responsibility. Therefore we believe that opening ethical discussions with clinicians about the sharing of genetic information, establishing guidelines for practice and sharing these guidelines and the reasons behind them with the wider population, will help to pre-empt ethical dilemmas.
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Affiliation(s)
- Aslihan Akpinar
- Department of History of Medicine and Ethics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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