Evans Nicholas Greig, Lipsitch Marc, Levinson Meira
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
J Med Ethics. 2015 Nov;41(11):901-8. doi: 10.1136/medethics-2014-102619. Epub 2015 Aug 28.
This paper proposes an ethical framework for evaluating biosafety risks of gain-of-function (GOF) experiments that create novel strains of influenza expected to be virulent and transmissible in humans, so-called potential pandemic pathogens (PPPs). Such research raises ethical concerns because of the risk that accidental release from a laboratory could lead to extensive or even global spread of a virulent pathogen. Biomedical research ethics has focused largely on human subjects research, while biosafety concerns about accidental infections, seen largely as a problem of occupational health, have been ignored. GOF/PPP research is an example of a small but important class of research where biosafety risks threaten public health, well beyond the small number of persons conducting the research.We argue that bioethical principles that ordinarily apply only to human subjects research should also apply to research that threatens public health, even if, as in GOF/PPP studies, the research involves no human subjects. Specifically we highlight the Nuremberg Code's requirements of 'fruitful results for the good of society, unprocurable by other methods', and proportionality of risk and humanitarian benefit, as broad ethical principles that recur in later documents on research ethics and should also apply to certain types of research not involving human subjects. We address several potential objections to this view, and conclude with recommendations for bringing these ethical considerations into policy development.
本文提出了一个伦理框架,用于评估功能获得性(GOF)实验的生物安全风险。这类实验会创造出预计对人类具有致病性和传染性的新型流感毒株,即所谓的潜在大流行病原体(PPP)。此类研究引发了伦理方面的担忧,因为实验室意外释放病原体可能导致这种致病性病原体广泛传播,甚至全球蔓延。生物医学研究伦理主要关注人体受试者研究,而对意外感染的生物安全担忧,很大程度上被视为职业健康问题,一直被忽视。GOF/PPP研究是一类规模虽小但很重要的研究实例,在这类研究中,生物安全风险对公众健康构成威胁,远远超出了进行研究的少数人员的范围。我们认为,通常仅适用于人体受试者研究的生物伦理原则,也应适用于威胁公众健康的研究,即便如GOF/PPP研究那样,该研究不涉及人体受试者。具体而言,我们强调《纽伦堡法典》中“为社会之福祉产生丰硕成果,且无法通过其他方法达成”的要求,以及风险与人文利益的相称性,这些作为宽泛的伦理原则,在后来关于研究伦理的文件中反复出现,也应适用于某些不涉及人体受试者的研究类型。我们探讨了对这一观点的几个潜在反对意见,并在文末给出了将这些伦理考量纳入政策制定的建议。