Klingler Corinna, Silva Diego Steven, Schuermann Christopher, Reis Andreas Alois, Saxena Abha, Strech Daniel
Institute of Ethics, History and Theory of Medicine at LMU Munich, Lessingstr. 2, 80336, Munich, Germany.
Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11008, 8888 University Drive, Burnaby, B.C, V5A 1S6, Canada.
BMC Public Health. 2017 Apr 4;17(1):295. doi: 10.1186/s12889-017-4200-4.
Public health surveillance is not ethically neutral and yet, ethics guidance and training for surveillance programmes is sparse. Development of ethics guidance should be based on comprehensive and transparently derived overviews of ethical issues and arguments. However, existing overviews on surveillance ethics are limited in scope and in how transparently they derived their results. Our objective was accordingly to provide an overview of ethical issues in public health surveillance; in addition, to list the arguments put forward with regards to arguably the most contested issue in surveillance, that is whether to obtain informed consent.
Ethical issues were defined based on principlism. We assumed an ethical issue to arise in surveillance when a relevant normative principle is not adequately considered or two principles come into conflict. We searched Pubmed and Google Books for relevant publications. We analysed and synthesized the data using qualitative content analysis.
Our search strategy retrieved 525 references of which 83 were included in the analysis. We identified 86 distinct ethical issues arising in the different phases of the surveillance life-cycle. We further identified 20 distinct conditions that make it more or less justifiable to forego informed consent procedures.
This is the first systematic qualitative review of ethical issues in public health surveillance resulting in a comprehensive ethics matrix that can inform guidelines, reports, strategy papers, and educational material and raise awareness among practitioners.
公共卫生监测并非在伦理上中立，然而，针对监测项目的伦理指导和培训却很匮乏。伦理指导的制定应基于对伦理问题和论据的全面且透明得出的概述。然而，现有的监测伦理概述在范围以及得出结果的透明度方面都存在局限。因此，我们的目标是提供一份公共卫生监测伦理问题的概述；此外，列出针对监测中最具争议的问题（即是否获取知情同意）所提出的论据。
基于原则主义定义伦理问题。我们假定当一个相关的规范性原则未得到充分考虑或两个原则发生冲突时，监测中就会出现伦理问题。我们在PubMed和谷歌图书中搜索相关出版物。我们使用定性内容分析法对数据进行分析和综合。
我们的搜索策略检索到525篇参考文献，其中83篇纳入分析。我们确定了在监测生命周期不同阶段出现的86个不同的伦理问题。我们还确定了20个不同的条件，这些条件使得放弃知情同意程序或多或少具有合理性。
这是对公共卫生监测伦理问题的首次系统性定性综述，得出了一个全面的伦理矩阵，可为指南、报告、战略文件和教育材料提供参考，并提高从业者的认识。
