Download - Consent and other legalities
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XX Conference Seattle 2005
Consent and other legalitiesMedLawconsult
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Sketching the discussion
What are biobanks … Residual tissue …
What legal issues …• Are ethical issues as well
Consent ‘Ownership’ privacy Feed-back of results Import- export, exchange
Against a background
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Background, balance of values
‘self determination’ / autonomy
Protection from ‘harm’ Privacy protection
Expectations of patients
Better prospects for future patients
Solidarity
‘freedom’ of research
Protection of harm Divide research
realm and economical world
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XX Conference Seattle 2005
Background2, other issues
Tissue (data) = economic value Patents, IPR
Commercial interest of researchers Economic interest for governments
Protecting research infrastructure > barriers exchange of tissue
Erosion of public trust Public / commercial culture, the culture of ‘feelings’ instead of ratio Those who feel wronged
Uneasy reaction by political elite Policy making on incidents Promises of a risk-free society Research easy target (even though nothing went wrong) Double bind because of economic value
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Background 3, ‘emperics’
Host of international documents UNESCO
• Human genetic data Council of Europe OECD WMA, ‘Helsinki’
• Race to the top
What do patients want Some kind of involvement Expect something in return, feed-back …
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What are biobanks
a collection of tissue which can be used for research
so with data connected …
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Types of
Population Prospective Tissue taken out for
research
gwa, large and see whether you find any correlations
Disease driven Retrospective Using residual tissue
Hypothesis driven
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For consent, what type of tissue
Coded anonymous tissue Double coding Sufficiently secure, researcher will not
retrieve identity
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Types of consent
Specific for each protocol Standard of clinical trials France, our CCMO
Multi choice consent Especially whether or not feed-back Commercial use etc. Council of Europe, Germany
Broad consent UK
Opt out Denmark, Netherlands , Belgium
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A cry for harmonisation ?
European Directive ?
Very naïve
Usually does not really harmonise Data protection Directive
Makes things more complicated Clinical trials Directive
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Clinical trials directive discussion
Not directly relevant However, now commonly recognised that it has
adverse effects for academic clinical research Me: q.e.d. for ‘harmonisation’ Various solutions suggested
More explanation More support for academic Researchers Trimming down the Directive A whole new Directive or even Regulation
encompassing all biomedical research, also epidemiological etc., so also biobanking
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No harmonisation at all ?
Yes, bottom up: Quality PET’s Basic ethics Governance
Not about consent The rule of recognition suffices for that
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Rule of recognition (Tubafrost)
If tissue may used for research at the country where it comes from according to the consent regulations of that country, it can also be used for that research in another country even if that other counry has different consent rules.
Home country control principle
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Feed back, Yes ?
Growing tendency in literature Participants seem to expect this Because of gwa and non hypothesis driven
research distinction between incidental findings and research results have become blurred
However, no obligation in recommendations etc. yet
UNESCO, right to know ‘your’ genetic data
Unless: individual case, acute, life threatening
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Good reasons for no individual feed-back
Statistical methods, too crude for personal prediction;
Coding makes it practically impossible Sheer number makes it practically unfeasible Time factor, comes too late Clinical meaning often still very unclear; Applies to all with this risk factor, if useful in
clinical practice should be applied to all … Biobanking is not screening Researchers are usually not the treating doctors Etc.
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However
Something must be done about:
Patient expectations Ideas of ownership, Benefit sharing Worries about privacy as DNA is seen
more and more as inherently identifiable
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Must avoid to be seen like this….
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Good Research Governance
- achieving a fair and transparent balance between the interests at stake
PUBLIC BENEFIT - bottom up Not only researchers, also with
interested patients Management of expectations…
Against often paternalistic tendencies of ethicists and regulators
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Harm from observational research, like biobanking ?
Data public good, if managed properly,
strict privacy protection no individual harm feasible
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Now, some of those good research governance principles
Transparency about projects and who is who Patient orientated website
Involvement patient groups Involvement other stakeholders All policies written out :
Policy of how are projects approved, how is scarce tissue used for projects etc.
Privacy protection IPR issues, balance researcher, inventor, contributors
to tissue bank, etc. Data-sharing Dissemination results of research Whether or not individual feed-back
In short: how project will benefit the public good