Ploug Thomas, Holm Søren
Centre for Applied Ethics and Philosophy of Science, Department of Communication, Aalborg University Copenhagen, A C Meyers Vænge, 2450, København SV, Denmark.
University of Manchester, Centre for Social Ethics and Policy, School of Law, Manchester, M13 9PL, UK.
BMC Med Ethics. 2017 Sep 15;18(1):53. doi: 10.1186/s12910-017-0212-y.
Research into personal health data holds great potential not only for improved treatment but also for economic growth. In these years many countries are developing policies aimed at facilitating such research often under the banner of 'big data'. A central point of debate is whether the secondary use of health data requires informed consent if the data is anonymised. In 2013 the Danish Minister of Health established a new register collecting data about all ritual male childhood circumcisions in Denmark. The main purpose of the register was to enable future research into the consequences of ritual circumcision.
This article is a study into the case of the Danish Circumcision Registry. We show that such a registry may lead to various forms of harm such as 1) overreaching social pressure, 2) stigmatization, 3) medicalization of a religious practice, 4) discrimination, and 5) polarised research, and that a person may therefore have a strong and legitimate interest in deciding whether or not such data should be collected and/or used in research. This casts doubt on the claim that the requirement of informed consent could and should be waived for all types of secondary research into registries. We finally sketch a new model of informed consent - Meta consent - aimed at striking a balance between the interests in promoting research and at the same time protecting the individual. Research participants may have a strong and legitimate interest in deciding whether or not their data should be collected and used for registry-based research whether or not their data is anonymised.
对个人健康数据的研究不仅在改善治疗方面具有巨大潜力,而且对经济增长也有潜在作用。近年来,许多国家都在制定政策以促进此类研究,这些政策通常打着“大数据”的旗号。一个核心争议点在于,如果健康数据已匿名化,那么对其进行二次使用是否还需要获得知情同意。2013年,丹麦卫生部长设立了一个新的登记处,收集丹麦所有男性儿童割礼仪式的数据。该登记处的主要目的是为未来对割礼仪式后果的研究提供便利。
本文是对丹麦割礼登记处这一案例的研究。我们表明,这样一个登记处可能会导致各种形式的伤害,例如:1)过度的社会压力;2)污名化;3)将一种宗教习俗医学化;4)歧视;5)研究两极分化。因此,个人可能有强烈且合理的利益诉求来决定此类数据是否应被收集以及是否应用于研究。这对下述主张提出了质疑,即对于登记处的所有类型的二次研究都可以且应该免除知情同意的要求。我们最终勾勒出一种新的知情同意模式——元同意,旨在在促进研究的利益与同时保护个人之间取得平衡。无论数据是否匿名化,研究参与者可能都有强烈且合理的利益诉求来决定他们的数据是否应被收集并用于基于登记处的研究。