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Sahan K, Lyle K, Carley H, Hallowell N, Parker MJ, Lucassen AM. Ethical preparedness in genomic medicine: how NHS clinical scientists navigate ethical issues. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109692. [PMID: 38320848 DOI: 10.1136/jme-2023-109692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
Much has been published about the ethical issues encountered by clinicians in genetics/genomics, but those experienced by clinical laboratory scientists are less well described. Clinical laboratory scientists now frequently face navigating ethical problems in their work, but how they should be best supported to do this is underexplored. This lack of attention is also reflected in the ethics tools available to clinical laboratory scientists such as guidance and deliberative ethics forums, developed primarily to manage issues arising within the clinic.We explore what ethical issues are being experienced by clinical scientists, how they think such issues could be best analysed and managed, and whether their practice might be enhanced by more situated approaches to ethics deliberation and practice such as ethical preparedness. From thematic analysis of cases presented by clinical scientists at a specially convened meeting of the UK Genethics Forum, we derived three main ethical themes: (1) the redistribution of labour and responsibilities resulting from the practice of genomic medicine; (2) the interpretation and certainty of results and (3) the proposal that better standardisation and consistency of ethical approaches (for example, more guidelines and policy) could resolve some of the challenges arising.We argue that although standardisation is important for promoting shared understandings of good (including ethical) practice, supplementary approaches to enhance and sustain ethical preparedness will be important to help clinical scientists and others in the recently expanded genetic/genomic medicine environment foster quality ethical thinking.
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Affiliation(s)
- Kate Sahan
- Ethox Centre, University of Oxford Nuffield Department of Population Health, Oxford, UK
| | - Kate Lyle
- Wellcome Trust Centre for Human Genetics, Oxford, UK
- Clinical Ethics, Law, and Society (CELS) Oxford, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Helena Carley
- Clinical Ethics, Law, and Society (CELS) Oxford, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
- South East Thames Regional Genetics Service, Guy's & St Thomas NHS Foundation Trust, London, UK
| | - Nina Hallowell
- Ethox Centre, University of Oxford Nuffield Department of Population Health, Oxford, UK
| | - Michael J Parker
- Ethox Centre, University of Oxford Nuffield Department of Population Health, Oxford, UK
| | - Anneke M Lucassen
- Wellcome Trust Centre for Human Genetics, Oxford, UK
- Clinical Ethics, Law, and Society (CELS) Oxford, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
- Centre for Personalised Medicine, University of Oxford, Oxford, UK
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Ibrahim K, Weller S, Elvidge E, Tavener M. Using collaborative autoethnography to explore the teaching of qualitative research methods in medicine. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1467-1483. [PMID: 37106221 PMCID: PMC10136391 DOI: 10.1007/s10459-023-10224-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/12/2023] [Indexed: 06/19/2023]
Abstract
This article explores experiences of teaching qualitative research (QR) broadly, and qualitative methods (QM) more specifically in medicine, highlighting the challenges faced, and offering recommendations for overcoming them. Using collective online interviews, collaborative autoethnography (CAE) was employed to generate data comprising educator's reflective accounts of teaching QM in medical schools across two continents. Three main themes were identified through collaborative thematic analysis: making meaningful contributions from a marginalized position; finding our pedagogical feet; and recognizing the translational applicability and value of QR. We reflected on the marginalized positioning of QM in medical curricula and the underestimation of the value of QR to understanding pressing health issues. Analysis of these reflections pointed to a lack of formal training for educators and curriculum space for qualitative approaches. Our teaching pedagogies, developed through our own research experiences, self-reflection and student feedback, were primarily student-centered employing a range of novel approaches designed to foster skills and interest in the craft of QR, and introduce a greater appreciation of the significance of QR approaches to medicine. CAE further allowed us to identify some key recommendations that could help medical educators plan for teaching QM and other research methods more effectively in medicine. Future curriculum development should consider the benefits of exposing learners to a range of methods and approaches from across the qualitative-quantitative spectrum.
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Affiliation(s)
- Kinda Ibrahim
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
- National Institute of Health and Care Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK.
| | - Susie Weller
- Clinical Ethics, Law and Society - Southampton, Faculty of Medicine, University of Southampton, Southampton, UK
- Clinical Ethics, Law and Society - Oxford, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Elissa Elvidge
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Meredith Tavener
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
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Parkinson B. We need to talk about research ethics committees (RECs). Evid Based Nurs 2023; 26:85-86. [PMID: 37137674 DOI: 10.1136/ebnurs-2023-103748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Ben Parkinson
- Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
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Farsides B, Lucassen AM. Ethical preparedness and developments in genomic healthcare. JOURNAL OF MEDICAL ETHICS 2023:jme-2022-108528. [PMID: 37268409 DOI: 10.1136/jme-2022-108528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 05/17/2023] [Indexed: 06/04/2023]
Abstract
Considerations of the notion of preparedness have come to the fore in the recent pandemic, highlighting a need to be better prepared to deal with sudden, unexpected and unwanted events. However, the concept of preparedness is also important in relation to planned for and desired interventions resulting from healthcare innovations. We describe ethical preparedness as a necessary component for the successful delivery of novel healthcare innovations, and use recent advances in genomic healthcare as an example. We suggest that practitioners and organisations charged with delivering innovative and ambitious healthcare programmes can only succeed if they are able to exhibit the attribute of ethical preparedness.
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Affiliation(s)
- Bobbie Farsides
- Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Anneke M Lucassen
- Clinical Ethics, Law and Society (CELS), Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
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Samuel G, Hardcastle F, Broekstra R, Lucassen A. Exploring how biobanks communicate the possibility of commercial access and its associated benefits and risks in participant documents. BMC Med Ethics 2022; 23:95. [PMID: 36131283 PMCID: PMC9491663 DOI: 10.1186/s12910-022-00829-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Biobanks and biomedical research data repositories collect their samples and associated data from volunteer participants. Their aims are to facilitate biomedical research and improve health, and they are framed in terms of contributing to the public good. Biobank resources may be accessible to researchers with commercial motivations, for example, researchers in pharmaceutical companies who may utilise the data to develop new clinical therapeutics and pharmaceutical drugs. Studies exploring citizen perceptions of public/private interactions associated with large health data repositories/biobanks indicate that there are sensitivities around public/private and/or non-profit/profit relationships and international sample and data sharing. Less work has explored how biobanks communicate their public/private partnerships to the public or to their potential research participants.
Methods We explored how a biobank’s aims, benefits and risks, and private/public relationships have been framed in public facing recruitment documents (consent forms and participant information sheets). Results Biobank documents often communicate their commercial access arrangements but not the detail about what these interactions would entail, and how risks and benefits would be distributed to the public. Conclusion We argue that this leads to a polarised discourse between public and private entities and/or activities, and fails to attend to the blurred lines between them. This results in a lack of attention to more important issues such as how risks and benefits in general are distributed to the public. We call for a nuanced approach that can contribute to the much-needed dialogue in this space.
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Affiliation(s)
- G Samuel
- Wellcome Trust Centre for Human Genetics and Centre for Personalised Medicine, University of Oxford, Oxford, OX3 7BN, UK. .,Clinical Ethics, Law and Society Research group, Faculty of Medicine, and Southampton NIHR Biomedical Research Centre., University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - F Hardcastle
- Wellcome Trust Centre for Human Genetics and Centre for Personalised Medicine, University of Oxford, Oxford, OX3 7BN, UK
| | - R Broekstra
- Clinical Ethics, Law and Society Research group, Faculty of Medicine, and Southampton NIHR Biomedical Research Centre., University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.,Department of Health Sciences, Section Health Psychology, University of Groningen, University Medical Center Groningen of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - A Lucassen
- Wellcome Trust Centre for Human Genetics and Centre for Personalised Medicine, University of Oxford, Oxford, OX3 7BN, UK.,Clinical Ethics, Law and Society Research group, Faculty of Medicine, and Southampton NIHR Biomedical Research Centre., University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
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