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5Getting rights right: implementing ‘Martha’s Rule’Journal of Medical Ethics. forthcoming.The UK government has recently committed to adopting a new policy—dubbed ‘Martha’s Rule’—which has been characterised as providing patients the right to rapidly access a second clinical opinion in urgent or contested cases. Support for the rule emerged following the death of Martha Mills in 2021, after doctors failed to admit her to intensive care despite concerns raised by her parents. We argue that framing this issue in terms of patient rights is not productive, and should be avoided. Insofar …Read more
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21Research ethics: An investigation of patients’ motivations for their participation in genetics-related researchJournal of Medical Ethics 36 (1): 37-45. 2010.Design: Qualitative interview study. Participants: Fifty-nine patients with a family history of cancer who attend a regional cancer genetics clinic in the UK were interviewed about their current and previous research experiences. Findings: Interviewees gave a range of explanations for research participation. These were categorised as social—research participation benefits the wider society by progressing science and improving treatment for everyone; familial—research participation may improve he…Read more
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Ethical implications of disparities in translation genomic medicine: from research to practiceJournal of Medical Ethics 50 (7): 435-436. 2024.Genomic medicine has the potential to contribute to the development of an array of novel technologies within the clinical armoury, making possible early detection and management of high-risk conditions such as cancer. While significant impact has already been felt in the context of rare inherited single gene disorders, much of the advancement in patient care through genomic medicine more broadly is going to be made possible by research involving large data sets that enable analyses of multiple g…Read more
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336The importance of getting the ethics right in a pandemic treatyThe Lancet Infectious Diseases 23 (11). 2023.The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore…Read more
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Genetics and dementia : ethical concernsIn Charles Foster, Jonathan Herring & Israel Doron (eds.), The law and ethics of dementia, Hart Publishing. 2014.
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10The challenges and potential solutions of achieving meaningful consent amongst research participants in northern Thailand: a qualitative studyBMC Medical Ethics 24 (1): 1-12. 2023.Background Achieving meaningful consent can be challenging, particularly in contexts of diminished literacy, yet is a vital part of participant protection in global health research. Method We explored the challenges and potential solutions of achieving meaningful consent through a qualitative study in a predominantly hill tribe ethnic minority population in northern Thailand, a culturally distinctive population with low literacy. Semi-structured interviews were conducted with 37 respondents who …Read more
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39Public involvement in the governance of population-level biomedical research: unresolved questions and future directionsJournal of Medical Ethics 47 (7): 522-525. 2021.Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to…Read more
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21BackgroundLiterature on issues relating to comprehension during the process of obtaining informed consent (IC) has largely focused on the challenges potential participants can face in understanding the IC documents, and the strategies used to enhance comprehension of those documents. In this review, we set out to describe the factors that have an impact on comprehension and the strategies used to enhance the IC process in sub-Saharan African countries.MethodsFrom November 2021 to January 2022, w…Read more
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48Discovering misattributed paternity in genetic counselling: different ethical perspectives in two countriesJournal of Medical Ethics 40 (3): 177-181. 2014.Misattributed paternity or ‘false’ paternity is when a man is wrongly thought, by himself and possibly by others, to be the biological father of a child. Nowadays, because of the progression of genetics and genomics the possibility of finding misattributed paternity during familial genetic testing has increased. In contrast to other medical information, which pertains primarily to individuals, information obtained by genetic testing and/or pedigree analysis necessarily has implications for other…Read more
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47‘It is an entrustment’: Broad consent for genomic research and biobanks in sub‐Saharan AfricaDeveloping World Bioethics 19 (1): 9-17. 2019.In recent years, there has been an increase in the establishment of biobanks for genetic and genomic studies around the globe. One example of this is the Human Heredity and Health in Africa Initiative (H3Africa), which has established biobanks in the sub‐region to facilitate future indigenous genomic studies. The concept of ‘broad consent’ has been proposed as a mechanism to enable potential research participants in biobanks to give permission for their samples to be used in future research stud…Read more
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17Moral Problems in Medicine: A Practical Coursebook: Michael Palmer, Cambridge, Lutterworth Press, 1999, 190 pages, pound14.15 (sc) (review)Journal of Medical Ethics 26 (6): 481-1. 2000.Moral Problems in Medicine is based on Michael Palmer's earlier, well-received, book, Moral Problems. The new book retains much of the structure of the earlier volume and the majority of its philosophical component. But whereas the earlier text was a course in applied philosophy covering such topics as warfare, crime and punishment and civil disobedience in addition to topics in medical ethics such as abortion and euthanasia, Moral Problems in Medicine focuses entirely on medicine. The text is p…Read more
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25Structural coercion in the context of community engagement in global health research conducted in a low resource setting in AfricaBMC Medical Ethics 21 (1): 1-10. 2020.Background While community engagement is increasingly promoted in global health research to improve ethical research practice, it can sometimes coerce participation and thereby compromise ethical research. This paper seeks to discuss some of the ethical issues arising from community engagement in a low resource setting. Methods A qualitative study design focusing on the engagement activities of three biomedical research projects as ethnographic case studies was used to gain in-depth understandin…Read more
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64ABSTRACT The use of broad consent for genomics research raises important ethical questions for the conduct of genomics research, including relating to its acceptability to research participants and comprehension of difficult scientific concepts. To explore these and other challenges, we conducted a study using qualitative methods with participants enrolled in an H3Africa Rheumatic Heart Disease genomics study (the RHDGen network) in Zambia to explore their views on broad consent, sample and data…Read more
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18How should assent to research be sought in low income settings? Perspectives from parents and children in Southern MalawiBMC Medical Ethics 20 (1): 32. 2019.Paediatric research in low-income countries is essential to tackle high childhood mortality. As with all research, consent is an essential part of ethical practice for paediatric studies. Ethics guidelines recommend that parents or another proxy provide legal consent for children to participate, but that children should be involved in the decision through providing assent. However, there remain uncertainties about how to judge when children are ready to give assent and about appropriate assent p…Read more
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48Ethics in practice: the state of the debate on promoting the social value of global health research in resource poor settings particularly AfricaBMC Medical Ethics 12 (1): 22. 2011.BackgroundPromoting the social value of global health research undertaken in resource poor settings has become a key concern in global research ethics. The consideration for benefit sharing, which concerns the elucidation of what if anything, is owed to participants, their communities and host nations that take part in such research, and the obligations of researchers involved, is one of the main strategies used for promoting social value of research. In the last decade however, there has been i…Read more
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21Stakeholder views on the acceptability of human infection studies in MalawiBMC Medical Ethics 21 (1): 1-15. 2020.BackgroundHuman infection studies (HIS) are valuable in vaccine development. Deliberate infection, however, creates challenging questions, particularly in low and middle-income countries (LMICs) where HIS are new and ethical challenges may be heightened. Consultation with stakeholders is needed to support contextually appropriate and acceptable study design. We examined stakeholder perceptions about the acceptability and ethics of HIS in Malawi, to inform decisions about planned pneumococcal cha…Read more
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61ABSTRACT The use of broad consent for genomics research raises important ethical questions for the conduct of genomics research, including relating to its acceptability to research participants and comprehension of difficult scientific concepts. To explore these and other challenges, we conducted a study using qualitative methods with participants enrolled in an H3Africa Rheumatic Heart Disease genomics study (the RHDGen network) in Zambia to explore their views on broad consent, sample and data…Read more
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24Key Ethical Concepts and Their Application to COVID-19 ResearchPublic Health Ethics 13 (2): 127-132. 2020.During the WHO-GloPID COVID-19 Global Research and Innovation Forum meeting held in Geneva on the 11th and 12th of February 2020 a number of different ethical concepts were used. This paper briefly states what a number of these concepts mean and how they might be applied to discussions about research during the COVID-19 pandemic and related outbreaks. This paper does not seek to be exhaustive and other ethical concepts are, of course, relevant and important.
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35Challenges arising when seeking broad consent for health research data sharing: a qualitative study of perspectives in ThailandBMC Medical Ethics 19 (1): 86. 2018.Research funders, regulatory agencies, and journals are increasingly expecting that individual-level data from health research will be shared. Broad consent to such sharing is considered appropriate, feasible and acceptable in low- and middle-income settings, but to date limited empirical research has been conducted to inform the design of such processes. We examined stakeholder perspectives about how best to seek broad consent to sharing data from the Mahidol Oxford Tropical Medicine Research U…Read more
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26SARS-CoV-2 challenge studies: ethics and risk minimisationJournal of Medical Ethics 47 (12). 2021.COVID-19 poses an exceptional threat to global public health and well-being. Recognition of the need to develop effective vaccines at unprecedented speed has led to calls to accelerate research pathways ethically, including by conducting challenge studies ) with SARS-CoV-2. Such research is controversial, with concerns being raised about the social, legal, ethical and clinical implications of infecting healthy volunteers with SARS-CoV-2 for research purposes. Systematic risk evaluations are crit…Read more
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22A qualitative study on aspects of consent for genomic research in communities with low literacyBMC Medical Ethics 21 (1): 1-7. 2020.BackgroundLow literacy of study participants in Sub - Saharan Africa has been associated with poor comprehension during the consenting process in research participation. The concerns in comprehension are far greater when consenting to participate in genomic studies due to the complexity of the science involved. While efforts are made to explore possibilities of applying genomic technologies in diseases prevalent in Sub Saharan Africa, we ought to develop methods to improve participants’ comprehe…Read more
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34Researcher and study participants’ perspectives of consent in clinical studies in four referral hospitals in VietnamBMC Medical Ethics 21 (1): 1-12. 2020.Within the research community, it is generally accepted that consent processes for research should be culturally appropriate and tailored to the context, yet researchers continue to grapple with what valid consent means within specific stakeholder groups. In this study, we explored the consent practices and attitudes regarding essential information required for the consent process within hospital-based trial communities from four referral hospitals in Vietnam. We collected surveys from and condu…Read more
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21Patient and public involvement: Two sides of the same coin or different coins altogether?Bioethics 33 (6): 708-715. 2019.Patient and public involvement (PPI) has gained widespread support in health research and health policy circles, but there is little consensus on the precise meaning or justifications of PPI. We argue that an important step towards clarifying the meaning and justification for PPI is to split apart the familiar acronym and draw a distinction between patient and public involvement. Specifically, we argue that patient involvement should refer to the practice of involving individuals in health resea…Read more
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44'Til Death Us Do Part: the ethics of postmortem gamete donationJournal of Medical Ethics 30 (4): 387-388. 2004.Couples need to make their wishes explicit if we are to allow postmortem gamete donation
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22Moral and scientific boundaries: research ethics on the Thai–Burma borderJournal of Medical Ethics 38 (9): 559-560. 2012.
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87Ethics of instantaneous contact tracing using mobile phone apps in the control of the COVID-19 pandemicJournal of Medical Ethics 46 (7): 427-431. 2020.In this paper we discuss ethical implications of the use of mobile phone apps in the control of the COVID-19 pandemic. Contact tracing is a well-established feature of public health practice during infectious disease outbreaks and epidemics. However, the high proportion of pre-symptomatic transmission in COVID-19 means that standard contact tracing methods are too slow to stop the progression of infection through the population. To address this problem, many countries around the world have deplo…Read more
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224Fair Allocation of Scarce Medical Resources in the Time of Covid-19New England Journal of Medicine 45. 2020.Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.
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3Forms of benefit sharing in global health research undertaken in resource poor settings: a qualitative study of stakeholders' views in KenyaPhilosophy, Ethics, and Humanities in Medicine 7 (1): 7. 2012.Background Increase in global health research undertaken in resource poor settings in the last decade though a positive development has raised ethical concerns relating to potential for exploitation. Some of the suggested strategies to address these concerns include calls for providing universal standards of care, reasonable availability of proven interventions and more recently, promoting the overall social value of research especially in clinical research. Promoting the social value of researc…Read more
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36Forms of benefit sharing in global health research undertaken in resource poor settings: a qualitative study of stakeholders' views in KenyaPhilosophy, Ethics, and Humanities in Medicine 7 7. 2012.Background Increase in global health research undertaken in resource poor settings in the last decade though a positive development has raised ethical concerns relating to potential for exploitation. Some of the suggested strategies to address these concerns include calls for providing universal standards of care, reasonable availability of proven interventions and more recently, promoting the overall social value of research especially in clinical research. Promoting the social value of researc…Read more
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King's College LondonAdministrator
Areas of Specialization
Philosophy of Social Science |
Philosophy of Physical Science |
General Philosophy of Science |