Hostname: page-component-5c6d5d7d68-tdptf Total loading time: 0 Render date: 2024-08-19T03:25:21.192Z Has data issue: false hasContentIssue false

Pediatric Participation in Non-Therapeutic Research

Published online by Cambridge University Press:  01 January 2021

Extract

Pediatric participation in non-therapeutic research that poses greater than minimal risk has been the subject of considerable thought-provoking debate in the research ethics literature. While the need for more pediatric research has been called morally imperative, and concerted efforts have been made to increase pediatric medical research, the importance of protecting children from undue research risks remains paramount.

United States research regulations are derived largely from the deliberations and report of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The authors of this report specifically designated children as a vulnerable population and suggested additional protections, most of which became U.S. law. One of the more contested sets of regulations surrounds non-therapeutic research, e.g., research that does not offer the potential for direct benefit to participants. Federal regulations allow local Institutional Review Boards (IRBs) to approve non-therapeutic research posing a minor increase above minimal risk when it involves children who have the disease or medical condition that the research addresses (Table 1).

Type
Independent
Copyright
Copyright © American Society of Law, Medicine and Ethics 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Shaddy, R. E. Denne, S. C., “The Committee on Drugs and Committee on Pediatric Research. Guidelines for the Ethical Conduct of Studies to Evaluate Drugs in Pediatric Populations,” Pediatrics 125, no. 4 (2010): 850860.CrossRefGoogle Scholar
National Institutes of Health, Policy and Guidelines for the Inclusion of Children as Participants in Research Involving Human Subjects, 1998 Children's Health Act, Public Law 106–310 Sec. 1004, 2000.Google Scholar
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, Report and Recommendations: Research Involving Children, DHEW Publication No. (OS) 77–0004, Washington D.C., 1977, at 94–121.Google Scholar
Nelson, R. M., The Scientific and Ethical Path Forward in Pediatric Product Development, 2010, available at <http://www.bioethics.nih.gov/hsrc/slides/Nelson%20-%20NIH%20HSP%20Course%2010-20-2010.pdf>(last visited September 4, 2012).(last+visited+September+4,+2012).>Google Scholar
Institute of Medicine and the National Academy, Field, M. J. Behrman, R., eds., Ethical Conduct of Clinical Research Involving Children (Washington, D.C.: National Academy Press, 2004).Google Scholar
Id.; Robinson, W. M., “Ethical Issues in Pediatric Research,” Journal of Clinical Ethics 11, no. 2 (2000): 145150; Kauffman, R. E., “Clinical Trials in Children: Problems and Pitfalls,” Paediatric Drugs 2, no. 6 (2000): 411–418; Ross, L. F., “Do Healthy Children Deserve Greater Protection in Medical Research?” Journal of Pediatrics 142, no. 2 (2003): 108–112; Freedman, B. Fuks, A. A. Weijer, C., “In Loco Parentis: Minimal Risk as an Ethical Threshold for Research upon Children,” Hastings Center Report 23, no. 2 (1993): 13–19; Fisher, C. B. Kornetsky, S. Z. Prentice, E. D., “Determining Risk in Pediatric Research with No Prospect of Direct Benefit: Time for a National Consensus on the Interpretation of Federal Regulations,” American Journal of Bioethics 7, no. 3 (2007): 5–10.Google Scholar
See National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, supra note 3.Google Scholar
See Institute of Medicine et al., supra note 5; Secretary's Advisory Committee on Human Research Protections (SACHRP), SACHRP Chair Letter to HHS Secretary Regarding Recommendations, 2005.Google Scholar
See Institute of Medicine et al.,; Council for International Organizations of Medical Sciences in collaboration with the World Health Organization, International Ethical Guidelines for Biomedical Research Involving Human Subjects, Geneva, 2002.Google Scholar
See Institute of Medicine et al., supra note 5.Google Scholar
Shah, S. Whittle, A. Wilfond, B. Gensler, G. Wendler, D., “How Do IRBs Apply the Federal Risk and Benefit Standards for Pediatric Research?” JAMA 291, no. 4 (2004): 476482; Janofsky, J. B. Starfield, B., “Assessment of Risk in Research on Children,” Journal of Pediatrics 98, no. 5 (1981): 842–846.CrossRefGoogle Scholar
Wendler, D. Emanuel, E. J., “What Is a “Minor” Increase over Minimal Risk?” Journal of Pediatrics 147, no. 5 (2005): 575578.Google Scholar
See Fisher, et al. , supra note 6.Google Scholar
See Freedman, et al. , supra note 6.Google Scholar
See Nelson, , supra note 4; Nelson, R. M. Ross, L. F., “In Defense of a Single Standard of Research Risk for All Children,” Journal of Pediatrics 147, no. 5 (2005): 565566; Redmon, R. B., “How Minors Can Be Respected as Ends Yet Still Be Used as Subjects in Non-Therapeutic Research,” Journal of Medical Ethics 12, no. 2 (1986): 77–82.CrossRefGoogle Scholar
Shah, S. Whittle, A. Wilfond, B. Gensler, G. Wendler, D., “How Do Institutional Review Boards Apply the Federal Risk and Benefit Standards for Pediatric Research?” JAMA 291, no. 4 (2004): 476482.CrossRefGoogle Scholar
Buchanan, D. R. Miller, F. G., “Justice and Fairness in the Kennedy Krieger Institute Lead Paint Study: The Ethics of Public Health Research on Less Expensive, Less Effective Interventions,” American Journal of Public Health 96, no. 5 (2006): 781787.CrossRefGoogle Scholar
Slovic, P., “Perception of Risk,” Science 236, no. 4799 (1987): 280285; Tversky, A. Kahnemen, D., “Judgment under Uncertainty: Heuristics and Biases,” Science 185, no. 415 (1974;): 1124–1131; Weinstein, N. D., “Optimistic Biases about Personal Risks,” Science 246, no. 4935 (1989): 1232–1233.CrossRefGoogle Scholar
Buchanan, A. E. Brock, D. W., Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge, NY: Cambridge University Press, 1989): At 123.Google Scholar
Ramsey, P., The Patient as Person (New Haven: Yale University Press, 1970).Google Scholar
Ramsey, P., “The Enforcement of Morals: Nontherapeutic Research on Children,” Hastings Center Report 6, no. 4 (1976): 2130.CrossRefGoogle Scholar
McCormick, R. A., “Experimentation in Children: Sharing in Sociality,” Hastings Center Report 6, no. 6):1976; 416–41.Google Scholar
Ackerman, T. F., “Moral Duties of Parents and Nontherapeutic Clinical Research Procedures Involving Children,” Bioethics Quarterly 2, no. 2 (1980): 94111; Ackerman, T. F., “Nontherapeutic Research Procedures Involving Chidlren with Cancer,” Journal of Pediatric Oncology Nursing 11, no. 3 (1994): 134–136.CrossRefGoogle Scholar
See Redmon, , supra note 15.Google Scholar
Nelson, J. L., “Taking Families Seriously,” Hastings Center Report 22, no. 4 (1992): 612.Google Scholar
Brendel, D. H. Miller, F. G., “A Plea for Pragmatism in Clinical Research Ethics,” American Journal of Bioethics 8, no. 4 (2008): 2431.CrossRefGoogle Scholar
Hursthouse, R., “Normative Virtue Ethics,” in Crisp, R. R., ed., How Should One Live: Essays on the Virtues, Oxford Scholarship Online, 1998, available at <http://www.oxford-scholarship.com/view/10.1093/0198752342.001.0001/acprof-9780198752349>(last visited September 4, 2012).CrossRef(last+visited+September+4,+2012).>Google Scholar
See National Commission for the Protection of Human Subjects of Biomedical Research, supra note 3.Google Scholar
Iltis, A., “Pediatric Research Posing a Minor Increase over Minimal Risk and No Prospect of Direct Benefit: Challenging 45 CFR 46.406,” Accountability in Research 14, no. 1 (2007): 1934.CrossRefGoogle Scholar
See Ross, , supra note 6.Google Scholar
Id.; Ross, L. F., “Correspondence: Protecting Research Subjects,” New England Journal of Medicine 346, no. 26 (2002): 20932095; Annas, G. J., “Questing for Grails: Duplicity, Betrayal and Self-Deception in Postmodern Medical Research: Contemporary Health Law and Policy,” Journal of Contemporary Health Law Policy 12, no. 2 (1996): 297–310; Arkin, L. M. Sondhi, D. Worgall, S. Hyon, L. Suk, L. H. K. Hackett, N. R. et al. , “Confronting the Issues of Therapeutic Misconception, Enrollment Decisions, and Personal Motives in Genetic Medicine-Based Clinical Research Studies for Fatal Disorders,” Human Gene Therapy 16, no. 9 (2005): 1028–1036; Appelbaum, P. S., “The Therapeutic Misconception: Informed Consent in Psychiatric Research,” International Journal of Law and Psychiatry 5, nos. 3–4 (1982): 319–321.Google Scholar
Cerulo, K. A., “Identity Construction: New Issues, New Directions,” Annual Review of Sociology 23, (1997): 385409; Hoggett, P., Contested Communities: Experiences, Struggles, Policies (Bristol, England: The Policy Press, 1997); Gusfield, J. R., The Community: A Critical Response (New York: Harper Colophon, 1975).CrossRefGoogle Scholar
McMillan, D. W. Chavis, D. M., “Sense of Community: A Definition and Theory,” Journal of Community Psychology 14, no. 1 (1986): 623; Beem, C., The Necessity of Politics: Reclaiming American Public Life (Chicago: University of Chicago Press, 1999): At 20.3.0.CO;2-I>CrossRefGoogle Scholar
Tonnies, F., Community and Society (Gemeinschaft und Gesellschaft) (New Brunswick, NJ: Transaction Publishers, 1887/1988): At 22.Google Scholar
See Buchanan, Brock, , supra note 19, at 234; Hardart, G. E. Troug, R. D., “Attitudes and Preferences of Intensivists Regarding the Role of Family Interests in Medical Decision Making for Incompetent Patients,” Critical Care Medicine 31, no. 7 (2003): 18951900; Hardart, G., “Including the Family's Interest in Medical Decision Making in Pediatrics,” Journal of Clinical Ethics 11, no. 2 (2000): 164–168; Blustein, J., “The Family in Medical Decision-Making,” Hastings Center Report 23, no. 3 (1993): 6–13; Hardwig, J., “The Problem of Proxies with Interests of Their Own: Toward a Better Theory of Proxy Decisions,” Journal of Clinical Ethics 4, no. 1 (1993): 20–27.Google Scholar
Schoeman, F., “Parental Discretion and Children's Rights: Background and Implications for Medical Decision-Making,” Journal of Medicine and Philospohy 10, no. 1 (1985): 4561.CrossRefGoogle Scholar
See National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, supra note 3;Google Scholar
see Institute of Medicine, supra note 5. See Nelson, , supra note 4.Google Scholar
See Annas, , supra note 31; see Arkin, , supra note 31; Ackerman, T. F., “The Ethics of Phase I Pediatric Oncology Trials,” IRB 17, no. 1 (1995): 15; Oberman, M. Frader, J., “Dying Children and Medical Research: Access to Clinical Trials as Benefit and Burden,” American Journal of Law & Medicine 29, nos. 2–3 (2003): 301–317.Google Scholar
See Annas, , supra note 31; see Arkin, et al. , supra note 31; see Oberman, Frader, , supra note 39.Google Scholar