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吹毛求疵?探索基因组研究中返还偶发发现的法律义务。

Finding Fault? Exploring Legal Duties to Return Incidental Findings in Genomic Research.

作者信息

Pike Elizabeth R, Rothenberg Karen H, Berkman Benjamin E

机构信息

Senior Policy and Research Analyst, Presidential Commission for the Study of Bioethical Issues. At the time of this work, Elizabeth Pike was a post-doctoral fellow in the Department of Bioethics at the National Institutes of Health. This Article was written by Elizabeth Pike in her private capacity. No official support or endorsement by the Presidential Commission for the Study of Bioethical Issues or the Department of Health and Human Services is intended, nor should it be inferred.

Marjorie Cook Professor of Law, founding Director of the Law & Health Care Program, former Dean of the University of Maryland School of Law, and Visiting Professor, Berman Institute of Bioethics, Johns Hopkins University. Professor Rothenberg currently serves as Senior Advisor on Genomics & Society to the Director of the National Human Genome Research Institute and Visiting Scholar in the Department of Bioethics at the National Institutes of Health.

出版信息

Georgetown Law J. 2014;102:795-843.

Abstract

The use of whole-genome sequencing in biomedical research is expected to produce dramatic advances in human health. The increasing use of this powerful, data-rich new technology in research, however, will inevitably give rise to incidental findings (IFs)-findings with individual health or reproductive significance that are beyond the aims of the particular research-and the related questions of whether and to what extent researchers have an ethical obligation to return IFs. Many have concluded that researchers have an ethical obligation to return some findings in some circumstances but have provided vague or context-dependent approaches to determining which IFs must be returned and when. As a result, researchers have started returning IFs inconsistently, giving rise to concerns about legal liability in circumstances in which notification could have potentially prevented injury. Although it is clear that ethical guidance should not be automatically codified as law and that crafting ethical obligations around legal duties can be inappropriate, the ethical debate should not proceed unaware of the potential legal ramifications of advancing and implementing an ethical obligation to return IFs. This Article assesses the legal claims that could be brought for a researcher's failure to return IFs. The potential for researchers to be held liable in tort is still uncertain and turns largely on a number of factors-including customary practice and guidance documents-that are still in flux. Unlike medical care, which has a well-defined duty into which evolving scientific knowledge about genetics and genomics can readily be incorporated, a researcher's duty to return IFs is less well defined, making it difficult to determine at the outset whether and when legal liability will attach. This Article advocates for a clearer, ethically sound standard of requiring that researchers disclose in the informed consent document which approach to offering IFs will be taken. This approach enables participants to know at the outset which findings, if any, will be returned, allows researchers to ascertain when their failure to appropriately return incidental findings will give rise to liability, and enables courts to make determinations that will produce more consistent legal guidance.

摘要

全基因组测序在生物医学研究中的应用有望在人类健康领域取得巨大进展。然而,这项强大且数据丰富的新技术在研究中的使用日益增加,不可避免地会产生偶然发现(IFs)——即具有个体健康或生殖意义、超出特定研究目标的发现——以及研究人员是否以及在何种程度上有道德义务反馈偶然发现这一相关问题。许多人得出结论,研究人员在某些情况下有道德义务反馈一些发现,但对于确定哪些偶然发现必须反馈以及何时反馈,他们提供的方法模糊或依赖具体情境。结果,研究人员反馈偶然发现的做法并不一致,引发了人们对在通知本可潜在预防伤害的情况下的法律责任的担忧。虽然很明显,道德指导不应自动编纂为法律,围绕法律义务制定道德义务可能不合适,但在推进和实施反馈偶然发现的道德义务时,道德辩论不应忽视其潜在的法律后果。本文评估了因研究人员未反馈偶然发现而可能引发的法律索赔。研究人员在侵权行为中承担责任的可能性仍不确定,很大程度上取决于一些仍在变化的因素,包括惯例做法和指导文件。与医疗护理不同,医疗护理有明确界定的义务,关于遗传学和基因组学的不断发展的科学知识可以很容易地纳入其中,而研究人员反馈偶然发现的义务界定不太明确,这使得一开始很难确定法律责任是否以及何时会产生。本文主张制定一个更清晰、符合道德标准的要求,即研究人员在知情同意文件中披露将采取哪种提供偶然发现的方法。这种方法能让参与者一开始就知道哪些发现(如果有的话)会被反馈,让研究人员确定何时他们未能适当地反馈偶然发现会导致责任,并使法院能够做出裁决,从而产生更一致的法律指导。

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