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涉及意识障碍患者的研究的伦理学问题。

Ethics Along the Continuum of Research Involving Persons with Disorders of Consciousness.

机构信息

NYU Langone Medical Center, 530 First Avenue, Skirball-7R, New York, NY, 10016, USA.

Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

出版信息

Neurocrit Care. 2023 Dec;39(3):565-577. doi: 10.1007/s12028-023-01708-2. Epub 2023 Mar 28.

Abstract

Interest in disorders of consciousness (DoC) has grown substantially over the past decade and has illuminated the importance of improving understanding of DoC biology; care needs (use of monitoring, performance of interventions, and provision of emotional support); treatment options to promote recovery; and outcome prediction. Exploration of these topics requires awareness of numerous ethics considerations related to rights and resources. The Curing Coma Campaign Ethics Working Group used its expertise in neurocritical care, neuropalliative care, neuroethics, neuroscience, philosophy, and research to formulate an informal review of ethics considerations along the continuum of research involving persons with DoC related to the following: (1) study design; (2) comparison of risks versus benefits; (3) selection of inclusion and exclusion criteria; (4) screening, recruitment, and enrollment; (5) consent; (6) data protection; (7) disclosure of results to surrogates and/or legally authorized representatives; (8) translation of research into practice; (9) identification and management of conflicts of interest; (10) equity and resource availability; and (11) inclusion of minors with DoC in research. Awareness of these ethics considerations when planning and performing research involving persons with DoC will ensure that the participant rights are respected while maximizing the impact and meaningfulness of the research, interpretation of outcomes, and communication of results.

摘要

在过去十年中,对意识障碍(DOC)的研究兴趣显著增加,这凸显了提高对 DOC 生物学、护理需求(监测使用、干预措施实施和情感支持提供)、促进康复的治疗选择以及预后预测的理解的重要性。探索这些主题需要意识到与权利和资源相关的许多伦理考虑因素。治疗昏迷运动伦理工作组利用其在神经危重病学、神经姑息治疗、神经伦理学、神经科学、哲学和研究方面的专业知识,制定了一项非正规审查,审查了涉及与以下方面相关的意识障碍患者的研究连续体中的伦理考虑因素:(1)研究设计;(2)风险与收益的比较;(3)纳入和排除标准的选择;(4)筛选、招募和入组;(5)同意;(6)数据保护;(7)向代理人和/或法定授权代表披露结果;(8)将研究转化为实践;(9)识别和管理利益冲突;(10)公平和资源可用性;(11)将意识障碍的未成年人纳入研究。在计划和进行涉及意识障碍患者的研究时,意识到这些伦理考虑因素将确保尊重参与者的权利,同时最大限度地提高研究的影响和意义、结果的解释以及结果的交流。

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