Hastings Cent Rep. 2022 May;52(3):2. doi: 10.1002/hast.1387.
Several pieces in the Hastings Center Report's May-June 2022 issue concern research ethics issues that arise in learning health care systems. In the lead article, Stephanie Morain and colleagues propose a new ethical framework for pragmatic clinical trials (PCTs), which are trials embedded in clinical care. Their framework consists of eight dimensions of demonstrating respect for patients enrolled in PCTs. In the second article, Robert Steel argues that patients being treated in a learning health care system can be required to participate in a clinical trial even if the risk to them is more than minimal. If they wish to refuse, they must either forgo treatment in the system or seek it elsewhere. Three commentaries explore various dimensions of Steel's argument. A third article in the issue turns in a different direction, to assumptions in bioethics about the quality of lives lived with disability. The authors, Debjani Mukherjee, Preya Tarsney, and Kristi Kirschner, find much that needs to change and offer recommendations for improvements at multiple levels.
《 Hastings 中心报告》2022 年 5-6 月刊的几篇文章涉及学习型医疗保健系统中出现的研究伦理问题。在首篇文章中，Stephanie Morain 及其同事为实用临床试验（PCT）提出了一个新的伦理框架，该框架将临床试验嵌入临床护理中。他们的框架由展示对参与 PCT 患者尊重的八个维度组成。在第二篇文章中，Robert Steel 认为，即使对患者的风险超过最小限度，在学习型医疗保健系统中接受治疗的患者也可能被要求参加临床试验。如果他们希望拒绝，他们必须要么放弃在该系统中的治疗，要么在其他地方寻求治疗。三篇评论文章探讨了 Steel 论点的各个方面。该期的第三篇文章则转向了生物伦理学中关于残疾生活质量的假设。作者 Debjani Mukherjee、Preya Tarsney 和 Kristi Kirschner 发现需要改变的地方很多，并在多个层面提出了改进建议。
