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Capps B, Chadwick R, Lederman Z, Lysaght T, Mills C, Mulvihill JJ, Oetting WS, Winship I. The Human Genome Organisation (HUGO) and a vision for Ecogenomics: the Ecological Genome Project. Hum Genomics 2023; 17:115. [PMID: 38111041 PMCID: PMC10726505 DOI: 10.1186/s40246-023-00560-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND The following outlines ethical reasons for widening the Human Genome Organisation's (HUGO) mandate to include ecological genomics. MAIN: The environment influences an organism's genome through ambient factors in the biosphere (e.g. climate and UV radiation), as well as the agents it comes into contact with, i.e. the epigenetic and mutagenic effects of inanimate chemicals and pollution, and pathogenic organisms. Emerging scientific consensus is that social determinants of health, environmental conditions and genetic factors work together to influence the risk of many complex illnesses. That paradigm can also explain the environmental and ecological determinants of health as factors that underlie the (un)healthy ecosystems on which communities rely. We suggest that The Ecological Genome Project is an aspirational opportunity to explore connections between the human genome and nature. We propose consolidating a view of Ecogenomics to provide a blueprint to respond to the environmental challenges that societies face. This can only be achieved by interdisciplinary engagement between genomics and the broad field of ecology and related practice of conservation. In this respect, the One Health approach is a model for environmental orientated work. The idea of Ecogenomics-a term that has been used to relate to a scientific field of ecological genomics-becomes the conceptual study of genomes within the social and natural environment. CONCLUSION The HUGO Committee on Ethics, Law and Society (CELS) recommends that an interdisciplinary One Health approach should be adopted in genomic sciences to promote ethical environmentalism. This perspective has been reviewed and endorsed by the HUGO CELS and the HUGO Executive Board.
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Affiliation(s)
- Benjamin Capps
- Department of Bioethics, Dalhousie University, 5849 University Avenue, CRC Building, Room C-312, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | | | | | - Tamra Lysaght
- National University of Singapore, Singapore, Singapore
| | | | - John J Mulvihill
- University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Brumbaugh J, Aguado BA, Lysaght T, Goldstein LSB. Human fetal tissue is critical for biomedical research. Stem Cell Reports 2023; 18:2300-2312. [PMID: 37977142 PMCID: PMC10724055 DOI: 10.1016/j.stemcr.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023] Open
Abstract
Human fetal tissue and cells derived from fetal tissue are crucial for biomedical research. Fetal tissues and cells are used to study both normal development and developmental disorders. They are broadly applied in vaccine development and production. Further, research using cells from fetal tissue is instrumental for studying many infectious diseases, including a broad range of viruses. These widespread applications underscore the value of fetal tissue research and reflect an important point: cells derived from fetal tissues have capabilities that cells from other sources do not. In many cases, increased functionality of cells derived from fetal tissues arises from increased proliferative capacity, ability to survive in culture, and developmental potential that is attenuated in adult tissues. This review highlights important, representative applications of fetal tissue for science and medicine.
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Affiliation(s)
- Justin Brumbaugh
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, CO, USA; University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, CO, USA; Charles C. Gates Center for Regenerative Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Brian A Aguado
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA; Sanford Consortium for Regenerative Medicine, La Jolla, CA, USA
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lawrence S B Goldstein
- Sanford Consortium for Regenerative Medicine, La Jolla, CA, USA; Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, CA, USA; Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
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3
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Kagan BJ, Gyngell C, Lysaght T, Cole VM, Sawai T, Savulescu J. The technology, opportunities, and challenges of Synthetic Biological Intelligence. Biotechnol Adv 2023; 68:108233. [PMID: 37558186 PMCID: PMC7615149 DOI: 10.1016/j.biotechadv.2023.108233] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/15/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023]
Abstract
Integrating neural cultures developed through synthetic biology methods with digital computing has enabled the early development of Synthetic Biological Intelligence (SBI). Recently, key studies have emphasized the advantages of biological neural systems in some information processing tasks. However, neither the technology behind this early development, nor the potential ethical opportunities or challenges, have been explored in detail yet. Here, we review the key aspects that facilitate the development of SBI and explore potential applications. Considering these foreseeable use cases, various ethical implications are proposed. Ultimately, this work aims to provide a robust framework to structure ethical considerations to ensure that SBI technology can be both researched and applied responsibly.
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Affiliation(s)
| | - Christopher Gyngell
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Victor M Cole
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tsutomu Sawai
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan; Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan
| | - Julian Savulescu
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia; Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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4
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Lysaght T, Chan HY, Scheibner J, Toh HJ, Richards B. An ethical code for collecting, using and transferring sensitive health data: outcomes of a modified Policy Delphi process in Singapore. BMC Med Ethics 2023; 24:78. [PMID: 37794387 PMCID: PMC10552227 DOI: 10.1186/s12910-023-00952-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
One of the core goals of Digital Health Technologies (DHT) is to transform healthcare services and delivery by shifting primary care from hospitals into the community. However, achieving this goal will rely on the collection, use and storage of large datasets. Some of these datasets will be linked to multiple sources, and may include highly sensitive health information that needs to be transferred across institutional and jurisdictional boundaries. The growth of DHT has outpaced the establishment of clear legal pathways to facilitate the collection, use and transfer of potentially sensitive health data. Our study aimed to address this gap with an ethical code to guide researchers developing DHT with international collaborative partners in Singapore. We generated this code using a modified Policy Delphi process designed to engage stakeholders in the deliberation of health data ethics and governance. This paper reports the outcomes of this process along with the key components of the code and identifies areas for future research.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Clinical Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Level 2 Block MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Hui Yun Chan
- Centre for Biomedical Ethics, Clinical Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Level 2 Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
| | - James Scheibner
- College of Business, Government & Law, Flinders University, Ring Road, Bedford Park South Australia 5042, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Hui Jin Toh
- Centre for Biomedical Ethics, Clinical Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Level 2 Block MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Bernadette Richards
- Academy for Medical Education, Medical School, The University of Queensland, 288 Herston Rd, Herston, QLD, 4006, Australia
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5
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Savulescu J, Labude M, Barcellona C, Huang Z, Leverentz MK, Xafis V, Lysaght T. Two kinds of embryo research: four case examples. J Med Ethics 2022; 48:590-596. [PMID: 35534151 PMCID: PMC9411897 DOI: 10.1136/medethics-2021-108038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/25/2021] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
There are ethical obligations to conduct research that contributes to generalisable knowledge and improves reproductive health, and this should include embryo research in jurisdictions where it is permitted. Often, the controversial nature of embryo research can alarm ethics committee members, which can unnecessarily delay important research that can potentially improve fertility for patients and society. Such delay is ethically unjustified. Moreover, countries such as the UK, Australia and Singapore have legislation which unnecessarily captures low-risk research, such as observational research, in an often cumbersome and protracted review process. Such countries should revise such legislation to better facilitate low-risk embryo research.We introduce a philosophical distinction to help decision-makers more efficiently identify higher risk embryo research from that which presents no more risks to persons than other types of tissue research. That distinction is between future person embryo research and non-future person embryo research. We apply this distinction to four examples of embryo research that might be presented to ethics committees.Embryo research is most controversial and deserving of detailed scrutiny when it potentially affects a future person. Where it does not, it should generally require less ethical scrutiny. We explore a variety of ways in which research can affect a future person, including by deriving information about that person, and manipulating eggs or sperm before an embryo is created.
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Affiliation(s)
- Julian Savulescu
- Faculty of Philosophy, University of Oxford, Oxford, UK
- Biomedical Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Markus Labude
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Capucine Barcellona
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Zhongwei Huang
- NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality, Singapore
- Institute of Molecular and Cell Biology, Agency of Science, Technology and Research, Singapore
- Obstetrics and Gynaecology, National University of Singapore, Singapore
| | | | - Vicki Xafis
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lysaght T, Schaefer GO, Voo TC, Wee HL, Joseph R. Professional Oversight of Emergency-Use Interventions and Monitoring Systems: Ethical Guidance From the Singapore Experience of COVID-19. J Bioeth Inq 2022; 19:327-339. [PMID: 35420376 PMCID: PMC9008394 DOI: 10.1007/s11673-022-10171-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
High degrees of uncertainty and a lack of effective therapeutic treatments have characterized the COVID-19 pandemic and the provision of drug products outside research settings has been controversial. International guidelines for providing patients with experimental interventions to treat infectious diseases outside of clinical trials exist but it is unclear if or how they should apply in settings where clinical trials and research are strongly regulated. We propose the Professional Oversight of Emergency-Use Interventions and Monitoring System (POEIMS) as an alternative pathway based on guidance developed for the ethical provision of experimental interventions to treat COVID-19 in Singapore. We support our proposal with justifications that establish moral duties for physicians to record outcomes data and for institutions to establish monitoring systems for reporting information on safety and effectiveness to the relevant authorities. Institutions also have a duty to support generation of evidence for what constitutes good clinical practice and so should ensure the unproven intervention is made the subject of research studies that can contribute to generalizable knowledge as soon as practical and that physicians remain committed to supporting learning health systems. We outline key differences between POEIMS and other pathways for the provision of experimental interventions in public health emergencies.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Yong Yoo Lin School of Medicine, Clinical Research Centre MD 11 #02-03, National University of Singapore, 10 Medical Drive, Singapore, Singapore
| | - Gerald Owen Schaefer
- Centre for Biomedical Ethics, Yong Yoo Lin School of Medicine, Clinical Research Centre MD 11 #02-03, National University of Singapore, 10 Medical Drive, Singapore, Singapore
| | - Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Yoo Lin School of Medicine, Clinical Research Centre MD 11 #02-03, National University of Singapore, 10 Medical Drive, Singapore, Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Roy Joseph
- Centre for Biomedical Ethics, Yong Yoo Lin School of Medicine, Clinical Research Centre MD 11 #02-03, National University of Singapore, 10 Medical Drive, Singapore, Singapore
- Department of Paediatrics, National University Hospital, Singapore, Singapore
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7
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Lysaght T. Anticipatory Governance and Foresight in Regulating for Uncertainty. Am J Bioeth 2022; 22:51-53. [PMID: 34962204 DOI: 10.1080/15265161.2021.2001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Toh HJ, Ballantyne A, Ong SAK, Sankaran C, Tay HY, Singh M, Zaidi R, Chia R, Singh S, Samachittananda S, Shi YG, Tan Z, Lysaght T. Religious Perspectives on Precision Medicine in Singapore. Asian Bioeth Rev 2021; 13:473-483. [PMID: 34611464 PMCID: PMC8486897 DOI: 10.1007/s41649-021-00180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
Precision medicine (PM) aims to revolutionise healthcare, but little is known about the role religion and spirituality might play in the ethical discourse about PM. This Perspective reports the outcomes of a knowledge exchange fora with religious authorities in Singapore about data sharing for PM. While the exchange did not identify any foundational religious objections to PM, ethical concerns were raised about the possibility for private industry to profiteer from social resources and the potential for genetic discrimination by private health insurers. According to religious authorities in Singapore, sharing PM data with private industry will require a clear public benefit and robust data governance that incorporates principles of transparency, accountability and oversight.
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Affiliation(s)
- Hui Jin Toh
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Angela Ballantyne
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Serene Ai Kiang Ong
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Raza Zaidi
- Jaafari Muslim Association Singapore, Singapore
| | - Roland Chia
- National Council of Churches of Singapore, Singapore
| | | | | | | | | | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lysaght T, Ballantyne A, Toh HJ, Lau A, Ong S, Schaefer O, Shiraishi M, van den Boom W, Xafis V, Tai ES. Trust and Trade-Offs in Sharing Data for Precision Medicine: A National Survey of Singapore. J Pers Med 2021; 11:921. [PMID: 34575698 PMCID: PMC8465970 DOI: 10.3390/jpm11090921] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Precision medicine (PM) programs typically use broad consent. This approach requires maintenance of the social license and public trust. The ultimate success of PM programs will thus likely be contingent upon understanding public expectations about data sharing and establishing appropriate governance structures. There is a lack of data on public attitudes towards PM in Asia. METHODS The aim of the research was to measure the priorities and preferences of Singaporeans for sharing health-related data for PM. We used adaptive choice-based conjoint analysis (ACBC) with four attributes: uses, users, data sensitivity and consent. We recruited a representative sample of n = 1000 respondents for an in-person household survey. RESULTS Of the 1000 respondents, 52% were female and majority were in the age range of 40-59 years (40%), followed by 21-39 years (33%) and 60 years and above (27%). A total of 64% were generally willing to share de-identified health data for IRB-approved research without re-consent for each study. Government agencies and public institutions were the most trusted users of data. The importance of the four attributes on respondents' willingness to share data were: users (39.5%), uses (28.5%), data sensitivity (19.5%), consent (12.6%). Most respondents found it acceptable for government agencies and hospitals to use de-identified data for health research with broad consent. Our sample was consistent with official government data on the target population with 52% being female and majority in the age range of 40-59 years (40%), followed by 21-39 years (33%) and 60 years and above (27%). CONCLUSIONS While a significant body of prior research focuses on preferences for consent, our conjoint analysis found consent was the least important attribute for sharing data. Our findings suggest the social license for PM data sharing in Singapore currently supports linking health and genomic data, sharing with public institutions for health research and quality improvement; but does not support sharing with private health insurers or for private commercial use.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.L.); (A.B.); (S.O.); (O.S.); (M.S.); (V.X.)
| | - Angela Ballantyne
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.L.); (A.B.); (S.O.); (O.S.); (M.S.); (V.X.)
- Department of Primary Health Care & General Practice, University of Otago, Wellington 6021, New Zealand
| | - Hui Jin Toh
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.L.); (A.B.); (S.O.); (O.S.); (M.S.); (V.X.)
| | - Andrew Lau
- Projective Insights Consultants, Singapore 590003, Singapore;
| | - Serene Ong
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.L.); (A.B.); (S.O.); (O.S.); (M.S.); (V.X.)
| | - Owen Schaefer
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.L.); (A.B.); (S.O.); (O.S.); (M.S.); (V.X.)
| | - Makoto Shiraishi
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.L.); (A.B.); (S.O.); (O.S.); (M.S.); (V.X.)
| | - Willem van den Boom
- Yale-NUS College, National University of Singapore, Singapore 138527, Singapore;
| | - Vicki Xafis
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (T.L.); (A.B.); (S.O.); (O.S.); (M.S.); (V.X.)
| | - E Shyong Tai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
- Precision Health Research, Singapore 139234, Singapore
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10
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Zeps N, Lysaght T, Chadwick R, Erler A, Foo R, Giordano S, San Lai P, Schaefer GO, Xafis V, Chew WL, Sugarman J. Ethics and regulatory considerations for the clinical translation of somatic cell human epigenetic editing. Stem Cell Reports 2021; 16:1652-1655. [PMID: 34214486 PMCID: PMC8282462 DOI: 10.1016/j.stemcr.2021.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022] Open
Abstract
Altering the human epigenome with gene-editing technology in attempt to treat a variety of diseases and conditions seems scientifically feasible. We explore some of the ethical and regulatory issues related to the clinical translation of human epigenetic editing arguing that such approaches should be considered akin to somatic therapies.
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Affiliation(s)
- Nikolajs Zeps
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Ruth Chadwick
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Alexandre Erler
- CUHK Centre for Bioethics, Chinese University of Hong Kong, Hong Kong, China; Philosophy Department, Chinese University of Hong Kong, Hong Kong, China
| | - Roger Foo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | | | - Poh San Lai
- Department of Paediatrics, National University of Singapore, Singapore, Singapore
| | - G Owen Schaefer
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vicki Xafis
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Leong Chew
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MA, USA
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11
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Lysaght T, Ballantyne A, Xafis V, Ong S, Schaefer GO, Ling JMT, Newson AJ, Khor IW, Tai ES. "Who is watching the watchdog?": ethical perspectives of sharing health-related data for precision medicine in Singapore. BMC Med Ethics 2020; 21:118. [PMID: 33213433 PMCID: PMC7678103 DOI: 10.1186/s12910-020-00561-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We aimed to examine the ethical concerns Singaporeans have about sharing health-data for precision medicine (PM) and identify suggestions for governance strategies. Just as Asian genomes are under-represented in PM, the views of Asian populations about the risks and benefits of data sharing are under-represented in prior attitudinal research. METHODS We conducted seven focus groups with 62 participants in Singapore from May to July 2019. They were conducted in three languages (English, Mandarin and Malay) and analysed with qualitative content and thematic analysis. RESULTS Four key themes emerged: nuanced understandings of data security and data sensitivity; trade-offs between data protection and research benefits; trust (and distrust) in the public and private sectors; and governance and control options. Participants were aware of the inherent risks associated with data sharing for research. Participants expressed conditional support for data sharing, including genomic sequence data and information contained within electronic medical records. This support included sharing data with researchers from universities and healthcare institutions, both in Singapore and overseas. Support was conditional on the perceived social value of the research and appropriate de-identification and data security processes. Participants suggested that a data sharing oversight body would help strengthen public trust and comfort in data research for PM in Singapore. CONCLUSION Maintenance of public trust in data security systems and governance regimes can enhance participation in PM and data sharing for research. Contrary to themes in much prior research, participants demonstrated a sophisticated understanding of the inherent risks of data sharing, analysed trade-offs between risks and potential benefits of PM, and often adopted an international perspective.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Angela Ballantyne
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Primary Health Care and General Practice, University of Otago, Dunedin, New Zealand
| | - Vicki Xafis
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Serene Ong
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gerald Owen Schaefer
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Ainsley J Newson
- Sydney Health Ethics, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, Australia
| | - Ing Wei Khor
- Department of Medicine,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
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Macneill P, Joseph R, Lysaght T, Samarasekera DD, Hooi SC. A professionalism program in medical education and training - From broad values to specific applications: YLL School of Medicine, Singapore. Med Teach 2020; 42:561-571. [PMID: 31990603 DOI: 10.1080/0142159x.2020.1714021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The process for introducing and developing a program for teaching medical professionalism at the National University of Singapore, School of Medicine is outlined. Professionalism was recognised as embracing 'honesty and integrity,' 'responsibility and participation,' 'respect and sensitivity,' and 'compassion and empathy.' Those broad values are expressed as specific attitudes and behaviours that are taught and assessed throughout the course. Honesty and integrity, for example, are demonstrated by 'presenting original, authentic assignments' (in medical education); and 'accepting personal mistakes and honestly acknowledging them' (in clinical training and practice). Values and items of behaviour were drawn from the literature, and reviewed and refined to address needs identified within the Medical School. A broad spectrum of pre-clinical and clinical teachers contributed to this development. The program was reassessed to determine the extent to which it has been implemented and has evolved following its adoption. The results are confirming in that: the majority of recommendations have been implemented; the program has developed further; and is supported by ancillary student enrichment activities. Medical professionalism has been given prominence through all phases of the course. Nevertheless, challenges remain and particularly in the extent to which medical professionalism is taught and assessed in various clinical postings.
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Affiliation(s)
- Paul Macneill
- Faculty of Medicine and Health, Sydney Health Ethics, The University of Sydney, Sydney, Australia
| | - Roy Joseph
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dujeepa D Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shing Chuan Hooi
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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13
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Stewart C, Kerridge I, Waldby C, Lipworth W, Munsie M, Lysaght T, Rudge C, Ghinea N, Eckstein L, Neilsen J, Kaldor J, Nicol D. Unconventional Practice, "Innovative" Interventions and the National Law. J Law Med 2020; 27:574-589. [PMID: 32406622] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This column explores a recent health profession disciplinary case which throws light on the problems of unconventional interventions by medical practitioners under the Health Practitioner Regulation National Law Act 2009 (Qld). The case involved "innovative" practices which were later found to have been scientifically unsupported, dangerous to patients and grounds for cancelling the health practitioner's registration. This column looks at common features of these kinds of cases in Australia and then examines recent attempts by the Medical Board of Australia to draft policy guidance around the use of unconventional practice in medicine. This column concludes with a number of changes to improve the effectiveness of the proposed policy.
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Affiliation(s)
| | | | - Catherine Waldby
- Research School of Social Sciences, Australian National University
| | | | | | - Tamra Lysaght
- Centre for Biomedical Ethics, National University of Singapore
| | - Christopher Rudge
- Postdoctoral Research Fellow, Sydney Health Law, University of Sydney
| | - Narcyz Ghinea
- Research Fellow, Sydney Health Ethics, University of Sydney
| | | | - Jane Neilsen
- Centre for Law and Genetics, University of Tasmania
| | - Jenny Kaldor
- Research Fellow, Centre for Law and Genetics, University of Tasmania
| | - Dianne Nicol
- Centre for Law and Genetics, University of Tasmania
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14
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Waldby C, Hendl T, Kerridge I, Lipworth W, Lysaght T, Munsie M, Stewart C. The direct-to-consumer market for stem cell-based interventions in Australia: exploring the experiences of patients. Regen Med 2020; 15:1238-1249. [DOI: 10.2217/rme-2019-0089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The prevalence of businesses selling autologous stem cell-based interventions to patients in Australia has raised serious concerns about how weaknesses in regulation have enabled the emergence of an industry that engages in aggressive marketing of unproven treatments to patients. Little is known about how patients experience this marketing and their subsequent interactions with practitioners. This paper reports results from 15 semistructured interviews with patients and carers, and also draws upon discussion conducted with patients, carers and family members (22 participants) in a workshop setting. We explore how Australian patients and carers understand and experience these interventions, and how their presumptions about the ethics of medical practice, and the regulatory environment in Australia have conditioned their preparedness to undergo unproven treatments.
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Affiliation(s)
- Catherine Waldby
- Research School of Social Sciences, College of Arts & Social Sciences, The Australian National University, Canberra, Australia
| | - Tereza Hendl
- Institute of Ethics, History & Theory of Medicine, Ludwig Maximilians University, Munich, Germany
| | - Ian Kerridge
- Sydney Health Ethics, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Wendy Lipworth
- Sydney Health Ethics, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Megan Munsie
- Centre for Stem Cell Systems, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
- Stem Cells Australia, Melbourne, Australia
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15
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Degeling C, Gilbert GL, Tambyah P, Johnson J, Lysaght T. One Health and Zoonotic Uncertainty in Singapore and Australia: Examining Different Regimes of Precaution in Outbreak Decision-Making. Public Health Ethics 2019. [DOI: 10.1093/phe/phz017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
A One Health approach holds great promise for attenuating the risk and burdens of emerging infectious diseases (EIDs) in both human and animal populations. Because the course and costs of EID outbreaks are difficult to predict, One Health policies must deal with scientific uncertainty, whilst addressing the political, economic and ethical dimensions of communication and intervention strategies. Drawing on the outcomes of parallel Delphi surveys conducted with policymakers in Singapore and Australia, we explore the normative dimensions of two different precautionary approaches to EID decision-making—which we call regimes of risk management and organizing uncertainty, respectively. The imperative to act cautiously can be seen as either an epistemic rule or as a decision rule, which has implications for how EID uncertainty is managed. The normative features of each regime, and their implications for One Health approaches to infectious disease risks and outbreaks, are described. As One Health attempts to move upstream to prevent rather than react to emergence of EIDs in humans, we show how the approaches to uncertainty, taken by experts and decision-makers, and their choices about the content and quality of evidence, have implications for who pays the price of precaution, and, thereby, social and global justice.
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Affiliation(s)
- C Degeling
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong and Sydney Health Ethics, School of Public Health, University of Sydney
| | - G L Gilbert
- Sydney Health Ethics, School of Public Health, University of Sydney and Marie Bashir Institute of Infectious Diseases and Biosecurity
| | - P Tambyah
- Department of Medicine, National University of Singapore and National University Health System
| | - J Johnson
- Sydney Health Ethics, School of Public Health, University of Sydney and Marie Bashir Institute of Infectious Diseases and Biosecurity
| | - T Lysaght
- Centre for Biomedical Ethics, National University of Singapore
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16
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Sugarman J, Barker RA, Kerridge I, Lysaght T, Pellegrini G, Sipp D, Tanner C. Tackling Ethical Challenges of Premature Delivery of Stem Cell-Based Therapies: ISSCR 2018 Annual Meeting Focus Session Report. Stem Cell Reports 2019; 11:1021-1025. [PMID: 30428384 DOI: 10.1016/j.stemcr.2018.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Clinical uses of unproven stem cell-based interventions abound, yet many patients may be harmed by receiving them, raising complex ethical, economic, and societal concerns. Regulators, scientists, clinicians, professional societies, and patient advocacy groups need to collaboratively articulate expectations related to the proper development and delivery of stem cell-based therapies.
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Affiliation(s)
- Jeremy Sugarman
- Berman Bioethics Institute and Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Roger A Barker
- John van Geest Centre for Brain Repair and Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Ian Kerridge
- Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
| | - Tamra Lysaght
- Centre for Biomedical Ethics, National University of Singapore
| | - Graziella Pellegrini
- Centre for Regenerative Medicine, University of Modena and Reggio Emilia, Modena MO, Italy
| | - Douglas Sipp
- Riken Center for Biosystems Dynamics Research and Keio University School of Medicine/Global Research Institute, Tokyo, Japan
| | - Claire Tanner
- The Centre for Stem Cell Systems (ELSI program), The University of Melbourne, Parkville, VIC, Australia
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17
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Lysaght T, Lim HY, Xafis V, Ngiam KY. AI-Assisted Decision-making in Healthcare: The Application of an Ethics Framework for Big Data in Health and Research. Asian Bioeth Rev 2019; 11:299-314. [PMID: 33717318 PMCID: PMC7747260 DOI: 10.1007/s41649-019-00096-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 12/13/2022] Open
Abstract
Artificial intelligence (AI) is set to transform healthcare. Key ethical issues to emerge with this transformation encompass the accountability and transparency of the decisions made by AI-based systems, the potential for group harms arising from algorithmic bias and the professional roles and integrity of clinicians. These concerns must be balanced against the imperatives of generating public benefit with more efficient healthcare systems from the vastly higher and accurate computational power of AI. In weighing up these issues, this paper applies the deliberative balancing approach of the Ethics Framework for Big Data in Health and Research (Xafis et al. 2019). The analysis applies relevant values identified from the framework to demonstrate how decision-makers can draw on them to develop and implement AI-assisted support systems into healthcare and clinical practice ethically and responsibly. Please refer to Xafis et al. (2019) in this special issue of the Asian Bioethics Review for more information on how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end of this paper.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vicki Xafis
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kee Yuan Ngiam
- Division of General Surgery (Thyroid & Endocrine Surgery), Department of Surgery, National University Hospital, Singapore
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18
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Xafis V, Schaefer GO, Labude MK, Brassington I, Ballantyne A, Lim HY, Lipworth W, Lysaght T, Stewart C, Sun S, Laurie GT, Tai ES. An Ethics Framework for Big Data in Health and Research. Asian Bioeth Rev 2019; 11:227-254. [PMID: 33717314 PMCID: PMC7747261 DOI: 10.1007/s41649-019-00099-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/26/2022] Open
Abstract
Ethical decision-making frameworks assist in identifying the issues at stake in a particular setting and thinking through, in a methodical manner, the ethical issues that require consideration as well as the values that need to be considered and promoted. Decisions made about the use, sharing, and re-use of big data are complex and laden with values. This paper sets out an Ethics Framework for Big Data in Health and Research developed by a working group convened by the Science, Health and Policy-relevant Ethics in Singapore (SHAPES) Initiative. It presents the aim and rationale for this framework supported by the underlying ethical concerns that relate to all health and research contexts. It also describes a set of substantive and procedural values that can be weighed up in addressing these concerns, and a step-by-step process for identifying, considering, and resolving the ethical issues arising from big data uses in health and research. This Framework is subsequently applied in the papers published in this Special Issue. These papers each address one of six domains where big data is currently employed: openness in big data and data repositories, precision medicine and big data, real-world data to generate evidence about healthcare interventions, AI-assisted decision-making in healthcare, public-private partnerships in healthcare and research, and cross-sectoral big data.
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Affiliation(s)
- Vicki Xafis
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - G. Owen Schaefer
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Markus K. Labude
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Iain Brassington
- Centre for Social Ethics and Policy, School of Law, University of Manchester, Manchester, UK
| | - Angela Ballantyne
- Department of Primary Health Care & General Practice, University of Otago, Dunedin, New Zealand
| | - Hannah Yeefen Lim
- Division of Business Law, College of Business, Nanyang Technological University, Singapore
| | - Wendy Lipworth
- Sydney Health Ethics, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Shirley Sun
- School of Social Sciences, College of Humanities, Arts, & Social Sciences, Nanyang Technological University, Singapore
| | - Graeme T. Laurie
- School of Law and JK Mason Institute for Medicine, Life Sciences and the Law, University of Edinburgh, Edinburgh, UK
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Division of Endocrinology, National University Hospital, Singapore
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19
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Capps B, Chadwick R, Joly Y, Lysaght T, Mills C, Mulvihill JJ, Zwart H. Statement on bioinformatics and capturing the benefits of genome sequencing for society. Hum Genomics 2019; 13:24. [PMID: 31142362 PMCID: PMC6542037 DOI: 10.1186/s40246-019-0208-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/12/2019] [Indexed: 11/10/2022] Open
Abstract
The HUGO Committee on Ethics, Law and Society (CELS) undertook a Working Group exploration of the key ethical issues arising from genome sequencing in 2013. The Imagined Futures paper the group subsequently published proposed points to consider when applying genomic bioinformatics to data repositories used in genomic medicine and research (http://www.hugo-international.org/Resources/Documents/CELS_Article-ImaginedFutures_2014.pdf). Given the ever-increasing power to sequence the human genome rapidly and inexpensively—as well as trends toward “Big Data” and “Open Science”—we take this opportunity to update and refine the key findings of that paper.
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Affiliation(s)
- Benjamin Capps
- Department of Bioethics, Dalhousie University, 5849 University Avenue, CRC Building, Room C-312, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada.
| | | | | | - Tamra Lysaght
- National University of Singapore, Singapore, Singapore
| | | | - John J Mulvihill
- University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Hub Zwart
- Erasmus University Rotterdam, Rotterdam, The Netherlands
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20
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Waldby C, Hendl T, Munsie M, Lysaght T, Lipworth W, Kerridge I, Stewart C. Autologous stem cell-based interventions in Australia: exploring patient experience in light of regulatory exceptionalism. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Lysaght T. International policy and ethics in human genome editing: An overview of position statements. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Lysaght T, Munsie M, Hendl T, Tan L, Kerridge I, Stewart C. Selling stem cells with tokens of legitimacy: An analysis of websites in Japan and Australia. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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23
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Lee TL, Lysaght T. Conditional Approvals for Autologous Stem Cell-Based Interventions: Conflicting norms and institutional legitimacy. Perspect Biol Med 2018; 61:59-75. [PMID: 29805148 DOI: 10.1353/pbm.2018.0027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Demands from patients, health-care professionals, and industry to streamline the market approval process for promising new therapies has prompted the introduction of programs that can provide more rapid access to stem cell-based products before evidence of safety and efficacy has been demonstrated in clinical trials. These products may be approved for marketing under "conditional authorizations," while uncertainty around safety and efficacy is reduced through the collection of clinical data in observational trials or registries. The rationale for conditional approval programs assumes that patients with unmet medical needs will benefit with rapid access to novel stem cell therapies. It also assumes that data gathered in actual clinical contexts is inherently better at reducing uncertainty than conventional clinical trial methods of demonstrating safety and efficacy. These assumptions may be overly optimistic and do not account for the broader societal burdens of prematurely releasing high-cost therapies with uncertain safety risks and benefits on to health-care markets. This essay focuses on the introduction of conditional approval programs for autologous somatic stem cell therapies and argues that these programs may conflict with, and potentially undermine, the normative commitments of regulatory agencies charged with promoting population health and protecting vulnerable groups from harm and exploitation. It concludes with suggestions of how programs designed to accelerate access to potentially helpful but experimental interventions could be reconfigured to be more equitable.
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24
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Lysaght T, Sugarman J. Editors' Introduction to the Special Section on Ethics, Policy, and Autologous Cellular Therapies. Perspect Biol Med 2018; 61:1-6. [PMID: 29805144 DOI: 10.1353/pbm.2018.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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25
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Bylstra Y, Lysaght T, Thrivikraman J, Watson S, Tan P. Ethical frameworks for obtaining informed consent in tumour profiling: an evidence-based case for Singapore. Hum Genomics 2017; 11:31. [PMID: 29221462 PMCID: PMC5723075 DOI: 10.1186/s40246-017-0127-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/30/2017] [Indexed: 01/24/2023] Open
Abstract
Background Genomic profiling of malignant tumours has assisted clinicians in providing targeted therapies for many serious cancer-related illnesses. Although the characterisation of somatic mutations is the primary aim of tumour profiling for treatment, germline mutations may also be detected given the heterogenous origin of mutations observed in tumours. Guidance documents address the return of germline findings that have health implications for patients and their genetic relations. However, the implications of discovering a potential but unconfirmed germline finding from tumour profiling are yet to be fully explored. Moreover, as tumour profiling is increasingly applied in oncology, robust ethical frameworks are required to encourage large-scale data sharing and data aggregation linking molecular data to clinical outcomes, to further understand the role of genetics in oncogenesis and to develop improved cancer therapies. Results This paper reports on the results of empirical research that is broadly aimed at developing an ethical framework for obtaining informed consent to return results from tumour profiling tests and to share the biomolecular data sourced from tumour tissues of cancer patients. Specifically, qualitative data were gathered from 36 semi-structured interviews with cancer patients and oncology clinicians at a cancer treatment centre in Singapore. The interview data indicated that patients had a limited comprehension of cancer genetics and implications of tumour testing. Furthermore, oncology clinicians stated that they lacked the time to provide in depth explanations of the tumour profile tests. However, it was accepted from both patients and oncologist that the return potential germline variants and the sharing of de-identified tumour profiling data nationally and internationally should be discussed and provided as an option during the consent process. Conclusions Findings provide support for the return of tumour profiling results provided that they are accompanied with an adequate explanation from qualified personnel. They also support the use of broad consent regiments within an ethical framework that promotes trust and benefit sharing with stakeholders and provides accountability and transparency in the storage and sharing of biomolecular data for research. Electronic supplementary material The online version of this article (10.1186/s40246-017-0127-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yasmin Bylstra
- POLARIS, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore. .,SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore. .,Inherited Cardiac Clinic, National University Hospital, Singapore, Singapore.
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jyothi Thrivikraman
- POLARIS, Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Sangeetha Watson
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Patrick Tan
- SingHealth Duke-NUS Institute of Precision Medicine, Singapore, Singapore.,Cancer and Stem Biology, Duke-NUS Medical School, Singapore, Singapore.,Biomedical Research Council, Agency for Science, Technology and Research, Singapore, Singapore
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26
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Munsie M, Lysaght T, Hendl T, Tan HYL, Kerridge I, Stewart C. Open for business: a comparative study of websites selling autologous stem cells in Australia and Japan. Regen Med 2017; 12:777-790. [PMID: 29125016 DOI: 10.2217/rme-2017-0070] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aim: This article examines online marketing practices of Japanese and Australian clinics offering putative autologous stem cell treatments. Materials & methods: We conducted google searches for keywords related to stem cell therapy and stem cell clinics in English and Japanese. Results: We identified websites promoting 88 point-of-sale clinics in Japan and 70 in Australia. Conclusion: Our findings provide further evidence of the rapid global growth in clinics offering unproven stem cell interventions. We also show that these clinics adopt strategies to promote their services as though they are consistent with evidentiary and ethical standards of science, research and medicine. Unless addressed, these practices risk harming not only vulnerable patients but also undermining public trust in science and medicine.
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Affiliation(s)
- Megan Munsie
- Centre for Stem Cell Systems, School of Biomedical Sciences, The University of Melbourne, Parkville, Australia
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore
| | - Tereza Hendl
- Center for Values, Ethics & the Law in Medicine, University of Sydney, Australia
| | - Hui-Yin Lynn Tan
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore
| | - Ian Kerridge
- Center for Values, Ethics & the Law in Medicine, University of Sydney, Australia.,Hematology Department, Royal North Shore Hospital, St Leonards, Sydney, Australia
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27
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Lysaght T, Lipworth W, Hendl T, Kerridge I, Lee TL, Munsie M, Waldby C, Stewart C. The deadly business of an unregulated global stem cell industry. J Med Ethics 2017; 43:744-746. [PMID: 28356490 DOI: 10.1136/medethics-2016-104046] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 11/09/2016] [Accepted: 03/09/2017] [Indexed: 06/06/2023]
Abstract
In 2016, the Office of the State Coroner of New South Wales released its report into the death of an Australian woman, Sheila Drysdale, who had died from complications of an autologous stem cell procedure at a Sydney clinic. In this report, we argue that Mrs Drysdale's death was avoidable, and it was the result of a pernicious global problem of an industry exploiting regulatory systems to sell unproven and unjustified interventions with stem cells.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Clinical Research Centre, National University of Singapore, Singapore, Singapore
| | - Wendy Lipworth
- Centre for Values Ethics and the Law in Medicine, University of Sydney, Sydney, Australia
| | - Tereza Hendl
- Centre for Values Ethics and the Law in Medicine, University of Sydney, Sydney, Australia
| | - Ian Kerridge
- Centre for Values Ethics and the Law in Medicine, University of Sydney, Sydney, Australia
- Haematology Department, Royal North Shore Hospital, Sydney, Australia
| | - Tsung-Ling Lee
- Centre for Biomedical Ethics, Clinical Research Centre, National University of Singapore, Singapore, Singapore
| | - Megan Munsie
- Stem Cells Australia, University of Melbourne, Melbourne, Australia
| | - Catherine Waldby
- College of Arts and Social Sciences, Australian National University, Canberra, Australia
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28
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Abstract
In 2014, the Japanese National Diet introduced new laws aimed at promoting the clinical translation of stem cells and regenerative medicine. The basic action of these laws is to allow the early introduction of regenerative medicine products into the Japanese market through an accelerated approval process, while providing patients with access to certain types of stem cell and cell-based therapies in the context of private clinical practice. While this framework appears to offer enormous opportunities for the translation of stem cell science, it raises ethical challenges that have not yet been fully explored. This paper critically analyzes this framework with respect to the prioritization of safety over clinical benefit, distributive justice and public trust in science and medicine. It is argued that the framework unfairly burdens patients and strained healthcare systems without any clear benefits, and may undermine the credibility of the regenerative medicine field as it emerges.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Yong LooLin School of Medicine, National University of Singapore, 119228, Singapore
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29
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Capps B, Chadwick R, Joly Y, Mulvihill JJ, Lysaght T, Zwart H. Falling giants and the rise of gene editing: ethics, private interests and the public good. Hum Genomics 2017; 11:20. [PMID: 28851444 PMCID: PMC5575847 DOI: 10.1186/s40246-017-0116-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/16/2017] [Indexed: 12/19/2022] Open
Abstract
This paper considers the tensions created in genomic research by public and private for-profit ideals. Our intent is to strengthen the public good at a time when doing science is strongly motivated by market possibilities and opportunities. Focusing on the emergence of gene editing, and in particular CRISPR, we consider how commercialisation encourages hype and hope-a sense that only promise and idealism can achieve progress. At this rate, genomic research reinforces structures that promote, above all else, private interests, but that may attenuate conditions for the public good of science. In the first part, we situate genomics using the aphorism that 'on the shoulders of giants we see farther'; these giants are infrastructures and research cultures rather than individual 'heroes' of science. In this respect, private initiatives are not the only pivot for successful discovery, and indeed, fascination in those could impinge upon the fundamental role of public-supported discovery. To redress these circumstances, we define the extent to which progress presupposes research strategies that are for the public good. In the second part, we use a 'falling giant' narrative to illustrate the risks of over-indulging for-profit initiatives. We therefore offer a counterpoint to commercialised science, using three identifiable 'giants'-scientists, publics and cultures-to illustrate how the public good contributes to genomic discovery.
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Affiliation(s)
- Benjamin Capps
- Department of Bioethics, Faculty of Medicine, Dalhousie University, Halifax, Canada.
| | - Ruth Chadwick
- School of Law, University of Manchester, Manchester, UK
| | - Yann Joly
- Department of Human Genetics, Centre of Genomics and Policy, McGill University, Québec, Canada
| | - John J Mulvihill
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma, USA
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hub Zwart
- Faculty of Science, Department of Philosophy and Science Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
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Lee TL, Lysaght T, Lipworth W, Hendl T, Kerridge I, Munsie M, Stewart C. Regulating the stem cell industry: needs and responsibilities. Bull World Health Organ 2017; 95:663-664. [PMID: 28867848 PMCID: PMC5578385 DOI: 10.2471/blt.16.189977] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/07/2017] [Accepted: 06/20/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Tsung-Ling Lee
- Centre for Biomedical Ethics, Clinical Research Centre, National University of Singapore, #02-03, 10 Medical Drive, 117597 Singapore
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Clinical Research Centre, National University of Singapore, #02-03, 10 Medical Drive, 117597 Singapore
| | - Wendy Lipworth
- Centre for Values, Ethics and the Law in Medicine, Sydney, University of Sydney, Australia
| | - Tereza Hendl
- Centre for Values, Ethics and the Law in Medicine, Sydney, University of Sydney, Australia
| | - Ian Kerridge
- Centre for Values, Ethics and the Law in Medicine, Sydney, University of Sydney, Australia
| | - Megan Munsie
- Stem Cells Australia, University of Melbourne, Melbourne, Australia
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Mulvihill JJ, Capps B, Joly Y, Lysaght T, Zwart HAE, Chadwick R. Ethical issues of CRISPR technology and gene editing through the lens of solidarity. Br Med Bull 2017; 122:17-29. [PMID: 28334154 DOI: 10.1093/bmb/ldx002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 01/30/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND The avalanche of commentaries on CRISPR-Cas9 technology, a bacterial immune system modified to recognize any short DNA sequence, cut it out, and insert a new one, has rekindled hopes for gene therapy and other applications and raised criticisms of engineering genes in future generations. SOURCES OF DATA This discussion draws on articles that emphasize ethics, identified partly through PubMed and Google, 2014-2016. AREAS OF AGREEMENT CRISPR-Cas9 has taken the pace and prospects for genetic discovery and applications to a high level, stoking anticipation for somatic gene engineering to help patients. We support a moratorium on germ line manipulation. AREAS OF CONTROVERSY We place increased emphasis on the principle of solidarity and the public good. The genetic bases of some diseases are not thoroughly addressable with CRISPR-Cas9. We see no new ethical issues, compared with gene therapy and genetic engineering in general, apart from the explosive rate of findings. Other controversies include eugenics, patentability and unrealistic expectations of professionals and the public. GROWING POINTS Biggest issues are the void of research on human germ cell biology, the appropriate routes for oversight and transparency, and the scientific and ethical areas of reproductive medicine. AREAS TIMELY FOR DEVELOPING RESEARCH The principle of genomic solidarity and priority on public good should be a lens for bringing clarity to CRISPR debates. The valid claim of genetic exceptionalism supports restraint on experimentation in human germ cells, given the trans-generational dangers and the knowledge gap in germ cell biology.
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Affiliation(s)
- John J Mulvihill
- Section of Genetics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Suite 12100, 1200 Children's Avenue, Oklahoma City, OK 73104, USA
| | - Benjamin Capps
- Department of Bioethics, Dalhousie University, 5849 University Avenue, Room C-312, CRC Bldg, PO Box 15000, Halifax, Nova Scotia, Canada B3H 4R2
| | - Yann Joly
- Department of Human Genetics, Centre of Genomics and Policy, McGill University, 740 Avenue Dr. Penfield, Suite 5200, Montreal (Quebec), Canada H3A 0G1
| | - Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Level 2 Block MD11, Clinical Research Centre, 10 Medical Drive, Singapore 117576, Singapore
| | - Hub A E Zwart
- Faculty of Science, Department of Philosophy and Science Studies, Radboud UniversityNijmegen, P.O. Box 9010, NL-6500 GL Nijmegen, The Netherlands
| | - Ruth Chadwick
- School of Law, University of Manchester, Williamson Building-2.13, Manchester M13 9PL, UK
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Lysaght T, Kerridge IH, Sipp D, Porter G, Capps BJ. Ethical and Regulatory Challenges with Autologous Adult Stem Cells: A Comparative Review of International Regulations. J Bioeth Inq 2017; 14:261-273. [PMID: 28247202 DOI: 10.1007/s11673-017-9776-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 10/06/2015] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
Cell and tissue-based products, such as autologous adult stem cells, are being prescribed by physicians across the world for diseases and illnesses that they have neither been approved for or been demonstrated as safe and effective in formal clinical trials. These doctors often form part of informal transnational networks that exploit differences and similarities in the regulatory systems across geographical contexts. In this paper, we examine the regulatory infrastructure of five geographically diverse but socio-economically comparable countries with the aim of identifying similarities and differences in how these products are regulated and governed within clinical contexts. We find that while there are many subtle technical differences in how these regulations are implemented, they are sufficiently similar that it is difficult to explain why these practices appear more prevalent in some countries and not in others. We conclude with suggestions for how international governance frameworks might be improved to discourage the exploitation of vulnerable patient populations while enabling innovation in the clinical application of cellular therapies.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, National University of Singapore, Level 2 Block MD11, Clinical Research Centre, 10 Medical Drive, 117576, Singapore, Singapore.
| | - Ian H Kerridge
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Medical Foundations Building K25, Sydney, NSW, 2006, Australia
| | - Douglas Sipp
- RIKEN Centre for Developmental Biology, 2-2-3 Minatojima-minamimachi Chuou-ku, Kobe, 650-004, Japan
| | - Gerard Porter
- School of Law, Edinburgh University, Old College, South Bridge, Edinburgh, EH8 9YL, Scotland
| | - Benjamin J Capps
- Department of Bioethics, Dalhousie University, 5849 University Avenue, Room C-315, CRC Bldg, PO Box 15000, Halifax, NS, B3H 4R2, Canada
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Lysaght T, Lederman Z, Tambyah PA. Authors’ reply: Comment on: Zika in Singapore: insights from One Health and social medicine. Singapore Med J 2017; 58:114. [DOI: 10.11622/smedj.2017011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lysaght T, Capps B, Bailey M, Bickford D, Coker R, Lederman Z, Watson S, Tambyah PA. Justice Is the Missing Link in One Health: Results of a Mixed Methods Study in an Urban City State. PLoS One 2017; 12:e0170967. [PMID: 28129409 PMCID: PMC5271361 DOI: 10.1371/journal.pone.0170967] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/14/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND One Health (OH) is an interdisciplinary collaborative approach to human and animal health that aims to break down conventional research and policy 'silos'. OH has been used to develop strategies for zoonotic Emerging Infectious Diseases (EID). However, the ethical case for OH as an alternative to more traditional public health approaches is largely absent from the discourse. To study the ethics of OH, we examined perceptions of the human health and ecological priorities for the management of zoonotic EID in the Southeast Asia country of Singapore. METHODS We conducted a mixed methods study using a modified Delphi technique with a panel of 32 opinion leaders and 11 semi-structured interviews with a sub-set of those experts in Singapore. Panellists rated concepts of OH and priorities for zoonotic EID preparedness planning using a series of scenarios developed through the study. Interview data were examined qualitatively using thematic analysis. FINDINGS We found that panellists agreed that OH is a cross-disciplinary collaboration among the veterinary, medical, and ecological sciences, as well as relevant government agencies encompassing animal, human, and environmental health. Although human health was often framed as the most important priority in zoonotic EID planning, our qualitative analysis suggested that consideration of non-human animal health and welfare was also important for an effective and ethical response. The panellists also suggested that effective pandemic planning demands regional leadership and investment from wealthier countries to better enable international cooperation. CONCLUSION We argue that EID planning under an OH approach would benefit greatly from an ethical ecological framework that accounts for justice in human, animal, and environmental health.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore
| | - Benjamin Capps
- Department of Bioethics, Dalhousie University, Halifax, Canada
| | - Michele Bailey
- Department of Physiology, National University of Singapore, Singapore, Singapore
| | - David Bickford
- Rimba, 4 Jalan 1/9D, Bandar Baru Bangi, Selangor, Malaysia
| | - Richard Coker
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zohar Lederman
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore
| | - Sangeetha Watson
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore
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Lysaght T, Lee TL, Watson S, Lederman Z, Bailey M, Tambyah PA. Zika in Singapore: insights from One Health and social medicine. Singapore Med J 2016; 57:528-529. [PMID: 27640519 DOI: 10.11622/smedj.2016161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tsung-Ling Lee
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sangeetha Watson
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zohar Lederman
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michele Bailey
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul Anantharajah Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Lysaght T, Lee T, Wong J, Sugii S. Accelerated Pathways for Cell Therapies in Japan: An Experiment in Ethics and Regulation. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Capps B, Bailey MM, Bickford D, Coker R, Lederman Z, Lover A, Lysaght T, Tambyah P. Introducing One Health to the Ethical Debate About Zoonotic Diseases in Southeast Asia. Bioethics 2015; 29:588-96. [PMID: 25675899 PMCID: PMC7161875 DOI: 10.1111/bioe.12145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Pandemic plans recommend phases of response to an emergent infectious disease (EID) outbreak, and are primarily aimed at preventing and mitigating human-to-human transmission. These plans carry presumptive weight and are increasingly being operationalized at the national, regional and international level with the support of the World Health Organization (WHO). The conventional focus of pandemic preparedness for EIDs of zoonotic origin has been on public health and human welfare. However, this focus on human populations has resulted in strategically important disciplinary silos. As the risks of zoonotic diseases have implications that reach across many domains outside traditional public health, including anthropological, environmental, and veterinary fora, a more inclusive ecological perspective is paramount for an effective response to future outbreaks.
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Abstract
Over the last decade, stem cell research has generated an enormous amount of public, political and bioethical debate. These debates have overwhelmingly tended to focus on two moral issues: the moral status of human embryos and the duty to care for the sick and vulnerable. This preoccupation, especially on the question of moral status, has not only dichotomized the debate around two fundamentally incommensurable positions, it has come at the cost of other important issues largely being ignored. In highlighting some of the bioethical and regulatory deficiencies of this fixation, we draw on recent developments in the experimental use of autologous adult stem cells to argue for a more inclusive approach to the ethical issues surrounding stem cell research.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228.
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Ann CS, Lysaght T. Underplayed Ethics and the Dilemmas of Psychiatric Care. Asian Bioeth Rev 2013. [DOI: 10.1353/asb.2013.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lysaght T. Disclosing Incidental Findings in Mental Health Research. Asian Bioeth Rev 2013. [DOI: 10.1353/asb.2013.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lysaght T. Ethics Commentary. Asian Bioeth Rev 2013. [DOI: 10.1353/asb.2013.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ahmad A, Lysaght T, Jianjun L, Subramaniam M, Say Beng T, Capps B. Understanding risk: psychosis and genomics research in Singapore. Genom Soc Policy 2012. [PMCID: PMC5417122 DOI: 10.1186/1746-5354-8-2-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This is an exploratory paper of the ethical implications for genomic research and mental illness with specific reference to Singapore. Singapore has a unique context due to its social and political systems, and although it is a relatively small country, its population is religiously and culturally diverse. The issues that we identify here, therefore, will offer new perspectives and will also shed light on the existing literature on psychiatric genomics in society. We contextualise issues such as risk and stigma in the identification and diagnosis of psychosis in the way they relate to Singaporean society, and use a current study (LYRIKS) as a case example. Genomic research has the potential to change significantly he practice of clinical medicine if, as expected, fast and inexpensive sequencing becomes a reality. It will likely also change how society thinks and acts in respect to multi-factorial diseases, conditions, traits, and syndromes that have a genetic component. Genomic research already raises a number of ethical concerns relating to the privacy of individuals, including the disclosure of research results and incidental findings, surreptitious tests, third party access to data, and the re-emergence of genetic determinism. These issues are potentially exacerbated when genomics - the study of whole genomes to understand complex illness and behavioural traits - is applied to psychiatric research, because of the stigma that is often attached to mental illness. In this paper, we discuss some of the issues that have arisen in the context of a study in Singapore that is currently investigating the genomics and biomarkers of psychosis. We argue that although a genomic study rarely creates data that is directly useful to the participant, it can have incidental benefits to the individual who is identified during the study as being at high risk of developing psychosis and its related states. Understanding these potential benefits requires us to examine the implications that this type of research may have on public understandings of genomic data and risk.
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Rekhi G, Capps B, Lysaght T, Chong SA. Reappraising consent: conducting ethical psychiatric research in Singapore. J Law Med 2012; 20:152-164. [PMID: 23156653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Singapore is legally restrictive when it comes to research involving minors. The age of majority is 21 and parental consent is required for participation in medical research. This article explores the age of majority and the issues related to obtaining consent for research in Singapore, focusing on "young adults" (17-21 years), using an example of a translational and clinical research project called the Longitudinal Youth at Risk Study (LYRIKS). It describes the unique legal and social conditions pertaining to the age of majority in Singapore, before presenting an argument for consideration as to whether the age of consent to participate in research should be reviewed. It concludes that rather than a set of doctrinaire rules for the age of participation in research, there should be an assessment of the kind of tasks that minors can assume themselves in respect to a specific project, and the degree of parental involvement.
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Affiliation(s)
- Gurpreet Rekhi
- Research Division, Institute of Mental Health/Woodbridge Hospital, Singapore.
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Lysaght T, Capps BJ, Campbell AV, Subramaniam M, Chong SA. Intervening in clinical research to prevent the onset of psychoses: conflicts and obligations. J Med Ethics 2012; 38:319-321. [PMID: 22159961 DOI: 10.1136/medethics-2011-100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A prevailing issue in clinical research is the duty clinicians have to treat or prevent the progression of disease during a study that they are conducting. While all clinical researchers have a duty of care for the patients who participate in clinical research, intervening at the onset or progression of disease may skew results and have a negative impact on the scientific validity of a study. Extreme examples of failures to intervene can be found in the Tuskegee syphilis study and in an attempt to determine if cervical smears were an accurate predictor of cancer, which was uncovered by the Cartwright Inquiry. However, the issue arises in all research where delay in intervention can cause harm. A current study in Singapore is investigating the significance of an 'ultra-high risk' state that may constitute the prodromal phase of psychosis. This project called 'The Longitudinal Youth at Risk Study' is potentially contentious because it is recruiting young people who are identified as being 'at risk' of developing psychosis. In this paper, the decision to offer treatment to all participants as well as a fast track for those who are assessed to have developed serious mental illness into treatment is discussed. It is argued that this approach is ethically justified because of the duty of care that is owed to research participants, and suggests that the principle of equipoise may be used to guide intervention decisions in other clinical research protocols.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, National University of Singapore, Singapore 119228.
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Lysaght T, Capps B, Subramaniam M, Chong SA. Translational and clinical research in Singapore: ethical issues in a longitudinal study of the prodromal phase of schizophrenia. Early Interv Psychiatry 2012; 6:3-10. [PMID: 22176693 DOI: 10.1111/j.1751-7893.2011.00318.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This paper aims to provide an overview of the ethical issues that have been raised by The Longitudinal Youth at Risk Study, which is being led by the Institute of Mental Health in Singapore as part of a multi-centre and multinational study in translational and clinical research in psychosis. This project is designed to identify the biomarkers of the trajectory to psychosis. As well as providing insights into the psychopathology and psychophysiology of the disease, the study will prospectively identify those in the Singaporean population with an ultra-high risk of developing psychosis. The project will collect both observational and clinically relevant data from an at-risk group: adolescents and young adults. METHODS A normative analysis was used to consider the ethical issues that arise as a result of this study, its methods, sample population and clinical management policy. RESULTS The project was found to raise particular and sensitive ethical and legal issues relating to the conduct of research with vulnerable populations who may be entering the prodromal phase of psychosis. Issues raised included notions of consent, privacy, confidentiality, stigmatization, duty of care and therapeutic misconception. CONCLUSION Whereas some of the issues raised by this study present with manageable solutions, others may be justifiable within the cultural context of Singapore and warrant further discussion.
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Affiliation(s)
- Tamra Lysaght
- Institute of Mental Health, Early Psychosis Intervention, Buangkok Green, Medical Park, Singapore.
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Lysaght T, Kerridge I. Rhetoric, power and legitimacy: a critical analysis of the public policy disputes surrounding stem cell research in Australia (2005-6). Public Underst Sci 2012; 21:195-210. [PMID: 22586845 DOI: 10.1177/0963662510368630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In December 2006, the Australian Parliament liberalized regulation governing stem cell research. This decision and preceding legislative review generated considerable public debate, which centred on objections to the deliberate creation and destruction of human embryos for research purposes. This paper draws on qualitative research conducted on the public debate surrounding this policy episode. The aim of this research was to examine how science and scientific knowledge are mobilized by participants in these debates to support their arguments. Data were collected from 109 newspaper opinion editorials as well as 23 in-depth interviews and examined using qualitative content and thematic analysis. Results of this analysis depict science as a rhetorical, moral and political resource that provides opportunities for participants to gain legitimacy, negotiate meaning and assert authority in the public domain. The mobilization of science in public discourse is discussed along with suggestions that are aimed at encouraging greater transparency and inclusiveness in public debates around contested science and emergent technologies.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, University of Singapore
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Lysaght T. Comparing public discourses in stem cell policy debates. J Law Med 2007; 14:575-82. [PMID: 17571787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Public policy debates surrounding stem cell research are becoming increasingly more complex as governance considerations move beyond the moral status of human embryos. This complexity is evident in the public discourses surrounding these debates globally. This article draws on the results of an analysis conducted on the media coverage of a recent stem cell policy episode in the United States to demonstrate the complexity of public discourses surrounding stem cell research and to reflect upon similar debates in Australia. Observations made from the public discourses in California are reframed within the Australian context to discuss ways in which future public policy debates surrounding stem cell research may be enriched.
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Affiliation(s)
- Tamra Lysaght
- Unit for the History and Philosophy of Science, Carslaw Building (F07), Faculty of Science, University of Sydney, Camperdown, NSW 2006, Australia.
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