Human Genome Research Project University of Otago Funded by the New Zealand Law Foundation
Dec 17, 2015
Newborn Screening:
Richman Wee
Project ManagerLaw Foundation-sponsored Human Genome Research Project
Envisioning Changing Expectations and
Future Proofing
• What started off interest in this
• Own thinking to date
- tidying up the ‘clutter’
re presentation at H Screening Symposium Oct2005
- ‘dancing around the most stirring issue’, re informed consent
Prelude
Look at the issue of ‘Informed Consent’
blood spot
collection
use (immediate and subsequent/secondary)
storage/destruction/return
transfer
Parental consent
Decision-making authority and process…
awareness, communication, information disclosure,
participation for the responsible care of
and interest of newborns
Today
Re-examining & Rethinking
Language and Concepts (Legal/Ethical)
Picture:
UK Newb Scn Prog Ctr,
Policies and standards,
Apr 2005, page 23
Roles Interests
Purpose(s) Purpose(s) & Expectation(s)
Rights Responsibilities
Consent Authorisation
Interests of various parties
• Whose and what interests?
Taking stock, weighing, reconciling all
interests, to extent possible, with the aim of
advancing relevant and key interests
• Balancing likelihood of Harm vs Benefit
• How can joint/shared responsibilities, duties and
rights – generally and overall –be better exercised or
respected in the (best) interest of relevant party/ies?
• Sense of time: immediate, short-term, long-term
and the bigger picture …
How …
- provide benefits and protect from harm
- promote relevant interests as best as possible
- fulfil the purpose(s) intended/agreed … keeping clearly
in mind and observing the central purpose
- meet expectations
- help & support decision-makers exercise their
responsibilities
?
CommunityCommunity/ies/ies
HealthcareHealthcareProvidersProviders
StateState(instns &(instns &
processes)processes)
ParentsParents
NewbornNewborn
Interests – whose ?
Expectations- Expectations within, and broadening, the
context of the ‘purpose(s)’ of an
intervention
When?
Whose?
What?
How to meet
them?
Why?
Responsibilities (cf rights)
… for care of the newborn
ParentsParents
HealthcareHealthcareProvidersProviders
Newborn
Authorisation- Comparing and Examining ‘Consent’
‘Types’ of Consent (cf. Refusal):
A. Explicit / Express Consent*
B. Exceptions to explicit / express consent*
1. Emergency*
2. Legislation* (Statutory Authorisation) – public
health, mental health legislation
*as per Wildeman & Downie
Authorisation- Comparing and Examining ‘Consent’
C. Implied Consent*
(1) Subsumed Consent*
i. sub-procedure or necessarily incidental to
procedure explicitly consented to
ii. contains a blanket consent to other
unspecified procedures
- significant nexus
*As per Wildeman & Downie
Authorisation- Comparing and Examining ‘Consent’
C. Implied Consent (cont.) *
(2) Consent inferred from conduct*
(3) Routine procedures*
(4) ‘Reasonable’ consent*
D. No Consent (Arguments from Impracticality*)
(1) Too costly*
(2) Too complex*
*as per Wildeman & Downie
Authorisation- Comparing and Examining ‘Consent’
Presumed Consent (Iceland Biobank, cadaveric organ
procurement)
Deferred Consent (emergency research)
Generic Consent for Genetic Screening (Annas 1994)
Proxy Consent (children, organ donation by legally
competent, some research contexts)
Substitute / Surrogate Consent (legally incompetent,
PVS, circumcision)
Authorisation
• Who from?
• Hierarchical (legally recognised) ordering ?
• What (substantive/content) ?
• When seek it ?
• How seek it ?
Authorisation
• Not intended to circumvent/undermine the notion of Consent
• Intended, as a starting point, to reflect and convey more
accurately what is going on
• Promote relevant interests and meet expectations
• Support responsible care of newborns
• Voluntary participation having ‘built-in barometer’ as
an indicator … also requiring initiatives to support
promotion of awareness & understanding
• Community/ies-dependent over time (bottom-up cf top-down, but consider dynamic exchange)
Postlude
Led by Prof Mark Henaghan, Dean of Law, Otago
Sponsored by NZ Law Foundation
web: www.otago.ac.nz/law/genome
e-mail: [email protected]