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Towards an Alternative Account for Defining Acceptable Risk in Non-beneficial Paediatric Research

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Ethics and Governance of Biomedical Research

Part of the book series: Research Ethics Forum ((REFF,volume 4))

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Abstract

The purpose of this paper is to propose an alternative account by which the ethical threshold of acceptable risk in paediatric research can be assessed. Three popular interpretations of the minimal risk threshold and the problems they raise when applied in the research context are presented. First, the “risks of daily life” standard and the “routine examinations” standard are addressed. It is argued here that neither of them can provide a satisfactory morally justified framework within which risks during paediatric non-therapeutic research should be assessed. The alternative view of the “charitable participation” standard is then discussed and the argument advanced that despite its advantages, it generates unavoidable difficulties when considered in the context of medical research. Finally, the author argues that consideration of the risk to which parents are willing to expose their children in a vaccination programme in the case of an infectious disease, which does not constitute a significant threat to them, can facilitate the definition of this threshold. Although the proposed account shares some of its strong points with those already existing, it does not lead to inconsistencies when applied in research context.

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Notes

  1. 1.

    The term child is used broadly here to refer to individuals below the age at which they can provide legal consent irrespectively of their capacity for consenting (following the definition of child in federal regulations on human research, which does not cite an age range: “persons who have not attained the legal age for consent to treatments or procedures involved in the research, under the applicable law of the jurisdiction in which the research will be conducted” (45 CFR 46.402(a); 21 CFR 50.3(o))). However, in the following paragraphs I argue that the concept of minimal risk should be age-adjusted.

  2. 2.

    For instance, many Phase 1 studies, which are conducted to determine a safe dose of the drug under investigation, essentially offer no chance of medical benefit and pose at least some risks. Moreover, Phase 3 studies, which randomise subjects to a potential new treatment or existing standard treatment, typically include individual non-beneficial procedures, such as additional blood draws, to evaluate the drugs being tested.

  3. 3.

    In some guidelines (Australia, Nepal and the U.S.) this definition is combined with the routine examinations standard (Wendler and Glantz 2007).

  4. 4.

    As the authors note there is some risk in hiring a new person, particularly one unknown to the family, for the care of one’s children. This is the reason why many parents feel a certain discomfort when they have to entrust the care of their children to someone else.

  5. 5.

    To assess new or complex studies, it is necessary to be able to appeal to a general concept of minimal risk, such as the “daily life risks” standard.

  6. 6.

    Most people accept vaccines in situations in which the incidence of a vaccine-preventable disease is high, the disease is potentially serious and the risks from the vaccine are proportionately low (NCB 2007).

  7. 7.

    Statistically, where there is fairly high vaccine coverage, the risks of disease for those who are unvaccinated may decrease (owing to population immunity) while the risks of vaccination remain (NCB 2007).

  8. 8.

    This is morally relevant since it could facilitate IRBs’ ability to make qualitative assessments on the socially acceptable levels of intentionally imposed risk that each country would allow parents to apply to their children for the social benefit.

  9. 9.

    This of course introduces a new risk threshold that must be determined, i.e., how much risk is justified by “vital importance”; however, the aim of this argument is to illustrate that the same moral justification for permitting an increase of the minimal risk threshold can be used in both cases.

  10. 10.

    Although the proposed standard of minimal risk has the same limitations as the “daily life” standard (more empirical data is needed for its implementation), the empirical database in the proposed standard is still better and this makes its implementation easier.

References

  • Advisory Committee on Human Radiation Experiments (ACHRE). 1995. Final report. Bethesda: U.S. Government Printing Office.

    Google Scholar 

  • Diekema, D.S., and F.B. Stapleton. 2006. Current controversies in pediatric research ethics: Proceedings introduction. The Journal of Pediatrics 149(1 Suppl): S1–S2.

    Article  Google Scholar 

  • Edwards, S., and J. Wilson. 2010. Hard paternalism, fairness and clinical research: Why not? Bioethics 26(2): 68–75.

    Article  Google Scholar 

  • Fisher, C.B., S.Z. Kornetsky, and E.D. Prentice. 2007. Determining risk in pediatric research with no prospect of direct benefit: Time for a national consensus on the interpretation of federal regulations. American Journal of Bioethics 7(3): 5–10.

    Article  Google Scholar 

  • Freedman, B., A. Fuks, and C. Weijer. 1993. In loco parentis minimal risk as ethical threshold for research upon children. Hastings Center Report 23(2): 13–19.

    Article  Google Scholar 

  • Glass, K.C., and M. Speyer-Ofenberg. 1996. Incompetent persons as research subjects and the ethics of minimal risk. Cambridge Quarterly of Healthcare Ethics 5(3): 362–372.

    Google Scholar 

  • Glass, K.C., and A. Binik. 2008. Rethinking risk in pediatric research. The Journal of Law, Medicine & Ethics 36(3): 567–576.

    Article  Google Scholar 

  • Janofsky, J., and B. Starfield. 1981. Assessment of risk in research on children. The Journal of Pediatrics 98(5): 842–846.

    Article  Google Scholar 

  • Kopelman, L.M. 2004. Minimal risk as an international ethical standard in research. Journal of Medicine and Philosophy 29(3): 351–378.

    Article  Google Scholar 

  • Korenman, S.G. 2004. Research in children: Assessing risks and benefits. Pediatric Research 56: 165–166.

    Article  Google Scholar 

  • Litton, P. 2008. Non-beneficial pediatric research and the best interests standard: A legal and ethical reconciliation. Yale Journal of Health Policy, Law, and Ethics 8(2): 359–420.

    Google Scholar 

  • Marshall, J.K. 2000. A critical approach to clinical practice guidelines. Canadian Journal of Gastroenterology 14(6): 505–509.

    Article  Google Scholar 

  • National Bioethics Advisory Commission (NBAC). 2001. Ethical and policy issues in research involving human participants. Report and recommendations of the National Bioethics Advisory Commission. Bethesda: U.S. Government Printing Office.

    Google Scholar 

  • Nelson, M.R. 2007. Minimal risk, yet again. The Journal of Pediatrics 150(6): 570–572.

    Article  Google Scholar 

  • Nuffield Council on Bioethics (NCB). 2007. Public health: Ethical issues. Cambridge: Cambridge Publishers Ltd.

    Google Scholar 

  • Resnik, D.B. 2005. Eliminating the daily life risks standard from the definition of minimal risk. Journal of Medical Ethics 31(1): 35–38.

    Article  Google Scholar 

  • Reynolds, W.W., and M.R. Nelson. 2008. Empirical data and the acceptability of research risk: A commentary on the charitable participation standard. Archives of Pediatrics and Adolescent Medicine 162(1): 88–90.

    Article  Google Scholar 

  • Rid, A., and D. Wendler. 2010. Risk-benefit assessment in medical research: Critical review and open questions. Law, Probality and Risk 9(3–4): 151–177.

    Article  Google Scholar 

  • Sharav, V.H. 2004. Alliance for human research protection: Author responds to letters on “children in clinical research: A conflict of moral values.”. American Journal of Bioethics 4(3): 36–37.

    Article  Google Scholar 

  • Tan, J.O., and M. Koelch. 2008. The ethics of pharmacological research in legal minors. Child & Adolescent Psychiatry & Mental Health 2: 39.

    Article  Google Scholar 

  • Tracey, E.C. 2006. The search for minimal risk in international pediatric clinical trials. Santa Clara Journal of Internationl Law 5(1): 8–33.

    Google Scholar 

  • Weijer, C. 2000. The ethical analysis of risk. The Journal of Law, Medicine & Ethics 28(4): 344–361.

    Article  Google Scholar 

  • Wendler, D. 2005. Protecting subjects who cannot give consent: Toward a better standard for “minimal” risks. Hastings Center Report 35(5): 37–43.

    Article  Google Scholar 

  • Wendler, D., and L. Glantz. 2007. A standard for assessing the risks of pediatric research: Pro and con. The Journal of Pediatrics 150(6): 579–582.

    Article  Google Scholar 

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Correspondence to Sapfo Lignou .

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Lignou, S. (2016). Towards an Alternative Account for Defining Acceptable Risk in Non-beneficial Paediatric Research. In: Strech, D., Mertz, M. (eds) Ethics and Governance of Biomedical Research. Research Ethics Forum, vol 4. Springer, Cham. https://doi.org/10.1007/978-3-319-28731-7_13

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