A research blog from the Centre for Resarch Ethics & Bioethics (CRB)

Author: Pär Segerdahl (Page 44 of 44)

Integrity of anonymous donors

In a comment on our Swedish blog (Etikbloggen), Joanna Forsberg asks if her integrity can be breached if a sample that she donated to a biobank is anonymized (so that it cannot be traced to her) and then is reused in new biobank research. Since the sample is not traceable to her, no one can approach her and ask for consent.

I will probably return to this question. I’m inclined to view an anonymized biological sample as a datum of humankind. A coded sample can become a datum of a specific individual, namely, if the code key is employed so that the donor is traced. The anonymous sample, however, cannot even become sample of “me,” since there is no code key. There is only some tissue and general information, like “male, 48 year old.” It does even not make sense, I want to say, then, to talk about my integrity in relation to anonymous samples.

I notice here that my reasoning is a little bit like that of an experimenter talking about what he or she wants to measure in the laboratory. But is my integrity like an experimental variable? Should bioethicists reason as if ethics was an experimental science?

Pär Segerdahl

We think about bioethics : www.ethicsblog.crb.uu.se

Have you cited a captive ape?

If you are writing on animal welfare, you may one day cite Savage-Rumbaugh, Wamba, Wamba and Wamba (2007). If you do, you will have cited one human and three captive bonobos.

I cited them last month, presenting a paper at the symposium, “Zoo-ethnographies,” arranged by the Centre for Gender Research in Uppsala. Citing them felt quite natural to me, since I’ve met the authors several times. Although only the human can write, all four understand spoken English and eloquently express their opinions about what you say and do. How do they communicate? Well, to focus on the nonhumans: the first day I visited the bonobos I happened to breach the rule, “just sit and observe,” by chatting with a caretaker just outside Panbanisha’s enclosure. Panbanisha heard when the rule was explained to me, and she looked offended and pointed QUIET on her portable keyboard with several hundred word symbols. I shivered with a combination of shame and metaphysical vertigo. A little later, I could not resist the temptation to touch her son’s hand. He ran to mother who was even more upset than before. She approached me with the keyboard and pointed to another symbol. A researcher asked, “Do you want to communicate with Pär?” She answered with the characteristic short high-pitched vocalization that she, Kanzi and Nyota use to answer questions in the affirmative. Her finger remained firmly on the symbol until I identified it and exclaimed: “She’s calling me a MONSTER!”

Being the first author, Sue Savage-Rumbaugh did the following. She asked the bonobos if they wanted to participate in a conversation about what they see as important for their welfare. They answered in the affirmative. During the tape-recorded conversation she presented a list of welfare items that she guessed might be important to them. It was presented as a series of yes-no questions. If there was uncertainty about a reply, the question was rephrased. Not all suggestions met with the bonobos’ approval. The final list of 12 items was presented in tabular form in the article.

Are Kanzi, Panbanisha and Nyota rightly listed as co-authors? I’ve witnessed the subtlety with which they respond to caretakers’ daily questions about their existence in captive environments. They undoubtedly had more direct verbal input to the article and clearer awareness and approval of their participation than many humans who’ve been listed as co-authors. They certainly were informants who answered questions in conversation with a researcher. But sometimes researchers, especially in ethnography, publish with their informants. I think that choice was particularly apt in this case.

The article concerned the welfare of this group of captive apes. Ever since Kanzi was young, Savage-Rumbaugh treated captivity not as an accidental feature of Kanzi and his family. The fact of captivity cannot be concealed with enrichment items and environments that appear natural for the species (a theme in the article). It is the core of the animal’s existence. If you take captive animals seriously and want to know what their lives can become like, you cannot hide captivity beneath a veneer of “naturalness.” You need to open-mindedly negotiate captivity on a daily basis. Kanzi, Panbanisha and Nyota are experts on their captive existence. Their language developed in negotiation of it. If you cite the article on their welfare as captive language competent apes, you certainly cite them.

Pär Segerdahl

The economisation of the language of medicine

Two American physicians recently wrote in the New England Journal of Medicine about how they were forced back to school again learning another foreign language. In medical school they learned that measles was called rubeola and itching pruritus. Today they learn that patient is called “customer” (or “consumer”) while doctor and nurse both are called “providers.”

The authors guess that spiralling health care costs drive this “economisation” of their professional language. Economists and politicians believe that the solution to the cost problematic lies in the industrialisation and standardisation of health care. Hospitals are to be run as modern businesses and the traditional language of medicine modified with terms that correspond to the professionals’ new factory functions. Above all, the patient relation is updated as a customer relation.

The two doctors see the economisation of their language as reductionist. It neglects the psychological, spiritual, and humanistic aspects of the relation to the patient. Precisely these aspects made medicine a “calling,” they write. The economisation of medicine concerns not only language, however, but also the organization of work. Doctors are less free to make their own decisions based on their clinical judgment. They are forced to follow manuals written by experts, as if they were on the factory floor following the chief engineer’s scheme.

When I read the article I thought that an alternative way of formulating the problem is in terms of means and ends. The authors’ note that clinical care always had a financial aspect, but the treatment of the patient still was in focus as the doctor’s primary goal. When profit took overhand as the goal, it was seen as a betrayal of the doctor’s calling and worth ridiculing, as in Moliere’s plays. The economisation of medicine turns the relation of means and ends inside out. The end of treating the patient is snatched out of the doctor’s hands and become a means towards other, economic ends. The analysis of the alienation this means is old and it is tempting to hear echoes from another century in the article’s finish, which I cannot avoid paraphrasing: “Doctors and nurses of the world, unite! Through off the language that demeans both patient and professional and that threatens the heart of medicine!”

Simultaneously, one must admit that new generations grow up that do not seem alienated in this new world, but act as self-evident consumers of health care.

Pär Segerdahl

We have a clinical perspective : www.ethicsblog.crb.uu.se

Does my blood sample make me a research subject?

When my blood sample is reused in biobank research, perhaps 5-10 years after I gave it, do I then become a research subject who must be informed about the new research project and give my assent before the sample is used?

The question arises when I read Joanna Forsberg’s article in BMJ on biobank research and the comments it received. She questions assent for each new biobank project in an interview on Nature News Blog. She thinks it is sufficient that the project has taken precautions that guarantee anonymity and is reviewed by an ethical review board.

Contacting people in thousands long after they gave their samples is not only costly, it also means drop out of samples threatening the validity of the results. Joanna thinks we all have an interest in the existence of biobank research even if we do not gain from research on precisely the samples we gave. Today vaccination against cervical cancer can be offered because in a biobank with patient samples from 1969 a connection was found between HPV virus infection and subsequent falling ill. As a reasonable solution Joanna therefore suggests broad consent to the use our samples in future biobank research.

I don’t know if research on my ten-year-old blood sample makes me a research subject today. One thing is obvious: biobank research does not resemble the standard image of medical research where research subjects after consent undergo treatments and regularly are tested.

Pär Segerdahl

We like ethics : www.ethicsblog.crb.uu.se

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