Ethical review not always in the patient’s best interest

Ethical review boards in practice deny patients access to the best medical knowledge by applying a view of autonomy that is too strict. This has consequences for both research and future care according to Mats G. Hansson, professor of biomedical ethics, in a recent article in the British Medical Journal.

Research on humans goes through ethical review in order to protect participants from harm. Ethical review boards place great importance on informed consent to research and several ethical guidelines have been written with the explicit purpose of making informed consent the general rule for all types of studies. Behind this focus on informed consent lies a restricted view of autonomy, says Mats G. Hansson.

-    This narrow view of autonomy that ethical review boards apply could in fact be harming patients’ interests. It leads to demands for both explicit and specific consent from participants in epidemiological research that only uses data from different types of registries and biobanks, he says.

Medical knowledge cannot be obtained unless people collaborate. Being autonomous is a matter of deciding for oneself, but not in isolation from others. As members of society we share an interest in the development of medical knowledge that leads to better treatments.

-    The very act of asking for consent will in itself reduce the number of participants in any study. Some people won’t answer and in fact, depending on the statistical power required in the study, just a few persons saying no could in some cases jeopardise results, says Mats G. Hansson.

This and many other ethical questions will be discussed at an international conference in Uppsala on June 14-16. The conference asks the question if medical ethics is really in the best interest of the patient.

More information: Mats G. Hansson, professor of biomedical ethics and director of the Centre for Research Ethics & Bioethics (CRB). mats.hansson@crb.uu.se, +46 471 61 97.

Centre website.

Conference website.

Reference: BMJ 5 May, 2010. Mats G Hansson, Need for a wider view of autonomy in epidemiological research. doi:10.1136/bmj.c2335