Hostname: page-component-7479d7b7d-8zxtt Total loading time: 0 Render date: 2024-07-11T12:26:58.569Z Has data issue: false hasContentIssue false

Rethinking the Regulatory Triggers for Prospective Ethics Review

Published online by Cambridge University Press:  01 January 2021

Abstract

Under the Common Rule, federally-supported activities involving human participants are presumptively required to undergo prospective ethics review if they are “designed to develop or contribute to generalizable knowledge.” However, the “generalizable knowledge” standard is inherently ambiguous; moreover, it is both over- and under-inclusive of the type of activities that warrant prospective ethical oversight. Rather than conditioning prospective ethics review on an ethically irrelevant criterion like the generalizable knowledge standard, this article proposes that prior ethics review should be required when some individuals are exposed to greater-than-minimal risks for the potential benefit of others, at least when the activity in question is conducted or supported by federal agencies. Under such an approach, the fact that an activity constitutes research would be neither necessary nor sufficient to trigger prospective ethical oversight.

Type
Symposium Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

45 C.F.R. § 46.102(1). The term “human subject” is defined as “a living individual about whom an investigator … conducting research (i) obtains information or biospecimens through intervention or interaction with the individual, and uses, studies, or analyzes the information or biospecimens; or (ii) obtains, uses, studies, analyzes, or generates identifiable private information or identifiable biospecimens.” 45 C.F.R. § 46.102(e).Google Scholar
See, e.g., University of California, San Diego Human Research Protections Program, “Fact Sheet: Oral History/Journalism Projects,” 2013, available at <https://irb.ucsd.edu/History_Journalism.pdf> (last accessed March 18, 2019) (defining “generalizable knowledge” as “[a]ctivities designed (with intent) to collect information about some individuals to draw general conclusions about other individuals that are predictive of future events and that can be widely applied as expressed in theories, principles, and statements and that enhance scientific or academic understanding”).+(last+accessed+March+18,+2019)+(defining+“generalizable+knowledge”+as+“[a]ctivities+designed+(with+intent)+to+collect+information+about+some+individuals+to+draw+general+conclusions+about+other+individuals+that+are+predictive+of+future+events+and+that+can+be+widely+applied+as+expressed+in+theories,+principles,+and+statements+and+that+enhance+scientific+or+academic+understanding”).>Google Scholar
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report (1979).Google Scholar
Kass, N. E., Faden, R.R., Goodman, S.N., Pronovost, P., Tunis, S., and Beauchamp, T. L., “The Research-Treatment Distinction: A Problematic Approach for Determining Which Activities Should Have Ethical Oversight,” Hastings Center Report 43, no. s1 (2013): S415 (“A public consensus emerged that research primarily serves the interests of science and of future patients rather than the interests of patients at hand, and that research is therefore prone, in ways clinical care is not, to exploit patients or expose them to unjustified harms.”); see also J. Wilson and D. Hunter, “Research Exceptionalism,” American Journal of Bioethics 10, no. 8 (2010): 45-54 (“While the combination of risk imposition with no expected benefit and little control over the risk is by no means unique to research, it is a feature that does seem to us to be sufficiently characteristic of research to at least partially justify more stringent regulation in the case of research.”).Google Scholar
See, e.g., Jones, J. H., Bad Blood: The Tuskegee Syphilis Experiment (The Free Press, 1981).Google Scholar
Rothman, D.J. and Rothman, S. M., The Willowbrook Wars: Bringing the Mentally Disabled into the Community (Aldine Transaction, 1984).Google Scholar
45 C.F.R. § 46.102(l)(1).Google Scholar
45 C.F.R. § 46.102(l)(2).Google Scholar
45 C.F.R. § 46.102(l)(3).Google Scholar
45 C.F.R. § 46.102(l)(4).Google Scholar
45 C.F.R. § 46.104(d)(3)(i).Google Scholar
45 C.F.R. § 46.104(d)(3)(ii).Google Scholar
45 C.F.R. § 46.101(b)(2)(i) (repealed).Google Scholar
45 C.F.R. § 46.104(d)(2)(iii).Google Scholar
45 C.F.R. § 46.102(b)(4) (repealed).Google Scholar
45 C.F.R. § 46.104(d)(4)(iii).Google Scholar
Kravitz, R. L., Duan, N., Vohra, Sunita, and Li, Jiang, “Introduction to N-of-1 Trials: Indications and Barriers,” in Design and Implementation of N-of-1 Trials: A User's Guide, Agency for Healthcare Research and Quality, 2014.Google Scholar
Cen, R., Hussain, A., Pak, K. J., Mitchell, G., Nikles, J., Gaudreau, S., Bazzano, L. A., and Breault, J. L., “Do N-of-1 Trials Need IRB Review?” Journal of Empirical Research on Human Research Ethics 11, no. 3 (2016): 250255.CrossRefGoogle Scholar
Cen et al., supra note 18.Google Scholar
See, e.g., Rothwell, P. M., “Factors That Can Affect the External Validity of Randomised Controlled Trials,” PLOS Clinical Trials 1, no. 1 (May 19, 2006): e9, available at <https://doi.org/10.1371/journal.pctr.0010009> (last visited May 24, 2019).CrossRefGoogle Scholar
See, e.g., Fiscella, K., Tobin, J. N., Carroll, J. K., He, H., and Ogedegbe, G., “Ethical Oversight in Quality Improvement and Quality Improvement Research: New Approaches to Promote a Learning Health Care System,” BMC Medical Ethics 16, no. 1 (December 2015) (noting that “generalizability represents a broad continuum without clear lines of demarcation”).CrossRefGoogle Scholar
Kringos, D. S., Sunol, R., Wagner, C., Mannion, R., Michel, P., Klazinga, N. S., and Groene, O., “The Influence of Context on the Effectiveness of Hospital Quality Improvement Strategies: A Review of Systematic Reviews,” BMC Health Services Research 15, no. 1 (2015): 277, available at <https://doi.org/10.1186/s12913-015-0906-0> (last visited March 19, 2019).CrossRefGoogle Scholar
Casarett, D., Karlawish, J. H.T., and Sugarman, J., “Determining When Quality Improvement Initiatives Should Be Considered Research: Proposed Criteria and Potential Implications,” JAMA 283, no. 17 (2000): 22752280.CrossRefGoogle Scholar
Centers for Disease Control and Prevention, Office of the Associate Director for Science. “Distinguishing Public Health Research and Public Health Nonresearch,” 2010, available at <https://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf> (last visited March 19, 2019).+(last+visited+March+19,+2019).>Google Scholar
See, e.g., American Law Institute, “Restatement 3d of Torts: Liability for Physical and Emotional Harm” § 1(b). 2010.Google Scholar
347 F.3d 672 (7th Cir. 2003).Google Scholar
Centers for Disease Control and Prevention, supra note 24.Google Scholar
Office for Human Research Protections, “Exempt Research Determination FAQs,” Text, HHS.gov, available at <https://www.hhs.gov/ohrp/regulations-and-policy/guidance/faq/exempt-research-determination/index.html> (last visited March 19, 2019).+(last+visited+March+19,+2019).>Google Scholar
Loe, J. D., Jonathan, , Winkelman, D. A., and Robertson, C. T., “An Assessment of the Human Subjects Protection Review Process for Exempt Research,” Journal of Law, Medicine & Ethics 44, no. 3 (2016): 481491, available at <https://doi.org/10.1177/1073110516667944> (last visited March 19, 2019).Google Scholar
Loe et al., supra note 29, at 487.Google Scholar
Federal Policy for the Protection of Human Subjects, § ____.104(d)(2). 82 Fed. Reg. 7149, 7183, Jan. 19, 2017, available at <https://www.gpo.gov/fdsys/pkg/FR-2017-01-19/pdf/2017-01058.pdf> (last visited March 19, 2019)(“The Final Rule”).+(last+visited+March+19,+2019)(“The+Final+Rule”).>Google Scholar
The Final Rule, supra note 31, at 7184.Google Scholar
Berger, M. L., Dreyer, N., Anderson, F., Towse, A., Sedrakyan, A., and Normand, S., “Prospective Observational Studies to Assess Comparative Effectiveness: The ISPOR Good Research Practices Task Force Report,” Value in Health 15, no. 2 (2012): 217230.CrossRefGoogle Scholar
Office for Human Research Protections, “Draft Guidance on Disclosing Reasonably Foreseeable Risks in Research Evaluating Standards of Care,” available at <https://www.hhs.gov/ohrp/regulations-and-policy/requests-for-comments/draft-guidance-disclosing-risk-in-standards-of-care/index.html> (last visited March 19, 2019).+(last+visited+March+19,+2019).>Google Scholar
Institute of Medicine, Roundtable on Value & Science-Driven Health Care, Integrating Research and Practice: Health System Leaders Working Toward High-Value Care, 2015, at 8.Google Scholar
See, e.g., Kass, N., Faden, R., and Tunis, S., “Addressing Low-Risk Comparative Effectiveness Research in Proposed Changes to US Federal Regulations Governing Research,” JAMA 307, no. 15 (2012): 15891590 (“In so many types of [comparative clinical effectiveness research] … studies generally pose no or only minimal additional risks or burdens to patients over what patients would experience in clinical care.”).Google Scholar
See, e.g., Kupersmith, J., “Advances in the Research Enterprise,” Hastings Center Report 43, no. S1 (2013): S4344 (suggesting that “more rigorous approaches may be discouraged by the greater administrative burdens imposed by regulations related to research”).CrossRefGoogle Scholar
See generally “Public Health Surveillance,” World Health Organization, available at <http://www.who.int/topics/public_health_surveillance/en/> (last visited March 19, 2019).+(last+visited+March+19,+2019).>Google Scholar
See, e.g., Rathi, P., Narendra, V., Sathiya, V., Kini, S., Kumar, A., Sana, N., Rohini, , and Kamath, V. G., “Measles Outbreak in the Adolescent Population — Matter of Concern?” Journal of Clinical and Diagnostic Research: JCDR 11, no. 8 (2017): LC20-LC23, available at <https://doi.org/10.7860/JCDR/2017/28619.10488> (March 19, 2019).Google Scholar
The Final Rule, supra note 31, at 7174.Google Scholar
See Lee, L. M., Heilig, C. M., and White, A., “Ethical Justification for Conducting Public Health Surveillance Without Patient Consent,” American Journal of Public Health 102, no. 1 (2011): 3844.CrossRefGoogle Scholar
See, e.g., Jonas, H., “Philosophical Reflections on Experimenting with Human Subjects,” Daedalus (1969): 219247.Google Scholar
45 C.F.R. § 46.116.Google Scholar
See Miller, F. G. and Brody, H., “Clinical Equipoise and the Incoherence of Research Ethics,” Journal of Medicine and Philosophy 32, no. 2 (2007): 151165 (identifying “non-exploitation” as the overarching principle of research ethics).CrossRefGoogle Scholar