期刊论文详细信息
Health Research Policy and Systems
Varying ethics rules in clinical research and routine patient care – research ethics committee chairpersons’ views in Finland
Piret Veerus2  Jorma I Virtanen3  Elina Hemminki1 
[1]Hjelt Institute/Department of Public Health, University of Helsinki, P.O. Box 41, 00014 Helsinki, Finland
[2]National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
[3]Oulu University Hospital, P.O. Box 21, 90220 Oulu, Finland
关键词: Regulation;    Informed consent;    Ethics;    Emergency research;    Cluster randomized trials;    Clinical research;   
Others  :  802484
DOI  :  10.1186/1478-4505-12-15
 received in 2013-10-04, accepted in 2014-03-12,  发布年份 2014
PDF
【 摘 要 】

Background

To present empirical data on how the variation in regulating clinical research and patient care was perceived in Finland between 2009 and 2012.

Methods

Notes of interviews with 22 research ethics committee (REC) chairpersons were analyzed to identify whether differences in the regulation of clinical research and patient care were addressed. REC chairpersons’ opinions on three imaginary cases of clinical research projects challenging current research ethics rules (vignettes) were requested with a questionnaire; 18 of the 22 interviewed chairpersons responded.

Results

Based on REC chairpersons’ interviews, the differences between care and research regulation were not considered important issues in Finland. In the vignettes, REC chairpersons’ assumptions on how their REC would decide varied in regard to allowing research without informed consent, while solutions that are not allowed by current law were even anticipated. Mostly, but not always, the chairpersons’ own personal view agreed with their REC.

Conclusions

The distinction between care and research regulation has not been publicly challenged by Finnish RECs, even though it is a challenge when research relevant to health care is carried out. There is a need for debate and changes in laws and practices.

【 授权许可】

   
2014 Hemminki et al.; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20140708024327284.pdf 187KB PDF download
【 参考文献 】
  • [1]Largent EA, Joffe S, Miller FG: Can research and care be ethically integrated? Hastings Cent Rep 2011, 41(4):37-46.
  • [2]Faden RR, Beauchamp TL, Kass NE: Learning health care systems and justice. Hastings Cent Rep 2011, 41(4):3.
  • [3]The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. April 18, 1979. [The Belmont Report, Office of the Secretary] [http://archive.hhs.gov/ohrp/humansubjects/guidance/belmont.htm webcite]
  • [4]IOM (Institute of Medicine): Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Workshop Summary. Washington DC: The National Academies Press; 2012.
  • [5]Rothwell PM: External validity of randomised controlled trials: “To whom do the results of this trial apply”. Lancet 2005, 365:82-93.
  • [6]IOM (Institute of Medicine): Public Engagement and Clinical Trials: New Models and Disruptive Technologies: Workshop Summary. Washington DC: The National Academies Press; 2011.
  • [7]Chalmers I: Regulation of therapeutic research is compromising the interests of patients. Int J Pharm Med 2007, 21:395-404.
  • [8]Harris J: Scientific research is a moral duty. J Med Ethics 2005, 31(4):242-248.
  • [9]Evans HM: Should patients be allowed to veto their participation in clinical research? J Med Ethics 2004, 30(2):98-203.
  • [10]Helgesson G, Eriksson S: Against the principle that the individual shall have priority over science. J Med Ethics 2008, 34(1):54-56.
  • [11]Chalmers I: It’s official: evaluative research must become part of routine care in the NHS. J R Soc Med 2000, 93(11):555-556.
  • [12]Tunis SR, Stryer DB, Clancy CM: Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA 2003, 290(12):1624-1632.
  • [13]Weisfeld V, English RA, Claiborne AB: Public Engagement and Clinical Trials. New Models and Disruptive Technologies. Workshop Summary. Washington DC: The National Academies Press; 2011.
  • [14]Ng SM, Weindling AM: The impact of networks on clinical trials in the United Kingdom. Trials 2009, 10:100. BioMed Central Full Text
  • [15]Moss AJ, Francis CW, Ryan D: Collaborative clinical trials. N Engl J Med 2011, 364(9):789-791.
  • [16]Staa TP, Goldacre B, Gulliford M, Cassell J, Pirmohamed M, Taweel A, Delaney B, Smeeth L: Pragmatic randomised trials using routine electronic health records: putting them to the test. BMJ 2012, 344:e55.
  • [17]Warlow C: Over-regulation of clinical research: a threat to public health. Clin Med 2005, 5(1):33-38.
  • [18]Medical ethics: should medicine turn the other cheek?: Medical ethics: should medicine turn the other cheek? Lancet 1990, 336:846-947.
  • [19]Chalmers I, Lindley RI: Double standards on informed consent to treatment. In Informed Consent in Medical Research. Edited by Doyal L, Tobias JS. London: BMJ Books; 2000:266-275.
  • [20]Chalmers I, Silverman WA: Professional and public double standards on clinical experimentation. Control Clin Trials 1987, 8:388-391.
  • [21]Hemminki E, Veerus P, Virtanen J, Lehto J: A qualitative study on clinical research in Finland – fragmented governance and volume in the 2000s. BMJ Open 2013, 3:e001856.
  • [22]Veerus P, Hemminki E, Lexchin J: Legislative regulation and ethical research governance of medical research in different European Union countries. J Med Ethics 2013. In press
  • [23]Hemminki E: Research ethics committees: agents of research policy? Health Res Policy Syst 2005, 3:6. BioMed Central Full Text
  • [24]McRae A, Taljaard M, Weijer C, Bennett C, Skea Z, Boruch R, Brehaut J, Eccles M, Grimshaw J, Donner A: Reporting of patient consent in healthcare cluster randomized trials is associated with the type of study interventions and publication characteristics. J Med Ethics 2013, 39:119-124.
  • [25]Giraudeau B, Caille A, LeGouge A, Ravaud P: Participant informed consent in cluster randomized trials: review. PLoS ONE 2012, 7(7):e40436.
  • [26]Roberts I, Prieto-Marino D, Shakur H, Chalmers I, Nicholl J: Effect of consent rituals on mortality in emergency care research. Lancet 2011, 377:1071-1072.
  • [27]EFGP: Effecting a Paradigm Shift so we do Inform Participants. Résidence Palace, Brussels, Belgium: ; [Report on EFGCP Annual Conference 2012 on Informed Consent – How Less Could be More; 24–25 January 2012] [http://www.efgcp.be/Downloads/confDocuments/Report%20of%20the%20EFGCP%202012%20Annual%20Conference.pdf webcite]
  • [28]IOM (Institute of Medicine): Envisioning a Transformed Clinical Trials Enterprise in the United Sates: Establishing an Agenda for, Workshop Summary. Washington DC: The National Academies Press; 2020:2012.
  • [29]Hakama M, Malila N, Dillner J: Randomised health services studies. Int J Cancer 2012, 131(12):2898-28902.
  • [30]Kramer JM, Smith PB, Califf RM: Impediments to clinical research in the United States. Clin Pharmacol Ther 2012, 91(3):535-541.
  • [31]McRae AD, Bennett C, Belle Brown J, Weijer C, Boruch R, Brehaut J, Chaudhry S, Donner A, Eccles M, Grimshaw J, Zwarenstein M, Taljaard M: Researchers’ perceptions of ethical challenges in cluster randomized trials: a qualitative analysis. Trials 2013, 14:1. BioMed Central Full Text
  • [32]Chalmers I: Trying to do more good than harm in policy and practice: the role of rigorous, transparent, up-to-date evaluations. Ann Am Acad Pol Soc Sci 2003, 589:22-40.
  • [33]Wade DT: Ethics, audit, and research: all shades of grey. BMJ 2005, 330:468-471.
  • [34]Perlman D: Rethinking local Institutional Review Board (IRB) review at state health departments. J Law Med Ethics 2012, 40(4):997-1007.
  • [35]Silberman G, Kahn KL: Burdens on research imposed by institutional review boards: the state of evidence and its implications for regulatory reform. Milbank Q 2011, 89(4):599-627.
  • [36]Academy of Medical Sciences: A New Pathway for the Regulation and Governance of Health Research. 2011. [http://www.acmedsci.ac.uk/p47prid88.html webcite]
  文献评价指标  
  下载次数:4次 浏览次数:44次