Selgelid Michael J
Centre for Human Bioethics, Monash University, Melbourne, Australia.
Sci Eng Ethics. 2016 Aug;22(4):923-964. doi: 10.1007/s11948-016-9810-1. Epub 2016 Aug 8.
Gain-of-function (GOF) research involves experimentation that aims or is expected to (and/or, perhaps, actually does) increase the transmissibility and/or virulence of pathogens. Such research, when conducted by responsible scientists, usually aims to improve understanding of disease causing agents, their interaction with human hosts, and/or their potential to cause pandemics. The ultimate objective of such research is to better inform public health and preparedness efforts and/or development of medical countermeasures. Despite these important potential benefits, GOF research (GOFR) can pose risks regarding biosecurity and biosafety. In 2014 the administration of US President Barack Obama called for a "pause" on funding (and relevant research with existing US Government funding) of GOF experiments involving influenza, SARS, and MERS viruses in particular. With announcement of this pause, the US Government launched a "deliberative process" regarding risks and benefits of GOFR to inform future funding decisions-and the US National Science Advisory Board for Biosecurity (NSABB) was tasked with making recommendations to the US Government on this matter. As part of this deliberative process the National Institutes of Health commissioned this Ethical Analysis White Paper, requesting that it provide (1) review and summary of ethical literature on GOFR, (2) identification and analysis of existing ethical and decision-making frameworks relevant to (i) the evaluation of risks and benefits of GOFR, (ii) decision-making about the conduct of GOF studies, and (iii) the development of US policy regarding GOFR (especially with respect to funding of GOFR), and (3) development of an ethical and decision-making framework that may be considered by NSABB when analyzing information provided by GOFR risk-benefit assessment, and when crafting its final recommendations (especially regarding policy decisions about funding of GOFR in particular). The ethical and decision-making framework ultimately developed is based on the idea that there are numerous ethically relevant dimensions upon which any given case of GOFR can fare better or worse (as opposed to there being necessary conditions that are either satisfied or not satisfied, where all must be satisfied in order for a given case of GOFR to be considered ethically acceptable): research imperative, proportionality, minimization of risks, manageability of risks, justice, good governance (i.e., democracy), evidence, and international outlook and engagement. Rather than drawing a sharp bright line between GOFR studies that are ethically acceptable and those that are ethically unacceptable, this framework is designed to indicate where any given study would fall on an ethical spectrum-where imaginable cases of GOFR might range from those that are most ethically acceptable (perhaps even ethically praiseworthy or ethically obligatory), at one end of the spectrum, to those that are most ethically problematic or unacceptable (and thus should not be funded, or conducted), at the other. The aim should be that any GOFR pursued (and/or funded) should be as far as possible towards the former end of the spectrum.
功能获得性(GOF)研究涉及旨在或预期会(和/或实际上确实会)增加病原体传播性和/或毒力的实验。此类研究由负责任的科学家进行时,通常旨在增进对致病因子、它们与人类宿主的相互作用以及/或者它们引发大流行的可能性的理解。此类研究的最终目标是为公共卫生和防范工作以及/或者医学应对措施的开发提供更充分的信息。尽管有这些重要的潜在益处,但功能获得性研究(GOFR)可能带来生物安全和生物安保方面的风险。2014年,美国总统巴拉克·奥巴马政府呼吁暂停对涉及流感、SARS和MERS病毒的功能获得性实验的资助(以及使用美国政府现有资金进行的相关研究)。随着这一暂停举措的宣布,美国政府启动了一个关于功能获得性研究的风险和益处的“审议程序”,以为未来的资助决策提供信息——美国国家生物安全科学咨询委员会(NSABB)被责成就此向美国政府提出建议。作为这一审议程序的一部分,美国国立卫生研究院委托撰写了这份伦理分析白皮书,要求其提供:(1)对功能获得性研究的伦理文献的回顾和总结;(2)识别和分析与以下方面相关的现有伦理和决策框架:(i)功能获得性研究的风险和益处评估,(ii)关于进行功能获得性研究的决策,以及(iii)美国关于功能获得性研究的政策制定(特别是在功能获得性研究的资助方面);(3)制定一个伦理和决策框架,NSABB在分析功能获得性研究风险效益评估提供的信息以及制定其最终建议(特别是关于功能获得性研究资助的政策决策)时可以考虑该框架。最终制定的伦理和决策框架基于这样一种理念,即对于任何给定的功能获得性研究案例,都有许多与伦理相关的维度,据此该案例的表现可能更好或更差(这与存在要么满足要么不满足的必要条件不同,所有必要条件都必须满足才能使给定的功能获得性研究案例被视为在伦理上可接受):研究必要性、相称性、风险最小化、风险可管理性、公正性、善治(即民主)、证据以及国际视野和参与。该框架的设计目的不是在伦理上可接受的功能获得性研究和伦理上不可接受的研究之间划一条清晰的界限,而是旨在表明任何给定的研究在伦理光谱上的位置——在这个光谱上,可想象的功能获得性研究案例可能从光谱一端那些在伦理上最可接受的(甚至可能在伦理上值得赞扬或在伦理上是义务性的),到另一端那些在伦理上最成问题或不可接受的(因此不应资助或进行)。目标应该是任何进行的(和/或资助的)功能获得性研究都应尽可能处于光谱的前一端。
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