The principle of solidarity and its relevance for tissue research

Published on August 31, 2015   37 min
0:00
AUDIENCE: Hello, my name is Barbara Prainsack. I'm a professor at the Department of Social Science, Health, and Medicine at King's College, London. As a department, we look at all the ways in which health is more than a medical matter. We're an interdisciplinary department. And my own work focuses on societal, ethical, and regulatory aspects of DNA testing and DNA databasing, specifically.
0:27
What I will talk about today are some of the societal challenges in and for tissue research and how the concept of solidarity can potentially help us address some of those challenges. I will start by outlining some of the challenges. Then I will say a few words about the concept of solidarity. And I will also say a few things about the meaning of solidarity vis-a-vis other related concepts, such as altruism or reciprocity. And as a third step, I will outline if solidarity can help us in addressing those challenges, how it can help us to do so.
1:10
As many people would know, tissue research is one of the key fields of medical research and actually medicine. Almost every aspect of medicine relies on tissue research in one way or another. And while it is difficult to delineate the field of tissue research precisely, there are several ways in which we can classify tissue research. One way of classifying it would be to look at the types of tissue that are being used, including blood, bone, ova, eggs, embryos, fetal tissue, neural tissue, or even whole organs. Another way of classifying tissue research would be to look at what the tissue is used for. And in terms of research, it could be used, for example, in the field of drug development, where as we know animal studies have findings that cannot be directly transposed to clinical applications for humans. So that would be one area in which tissue is used for research. But there are, of course, other uses, so that is the second type of classifying tissue research. Another type would be to look at whether the tissue is a byproduct of clinical practice or whether it was collected and stored for research purposes explicitly. And another way of classifying it would be according to what people the issue comes from, what type of person. Would it be living people? Or would it be tissue from deceased people?
2:45
And for all of those, what pertains to all of those categories is that providing enough tissue for research is one of the major challenges. There are several reasons for a lack of supply of tissue. They depend, really, on what area of tissue research we're talking about and what source of tissue we're talking about. But the reasons for the shortage of tissue for research have to do with the fact that sometimes people are not being asked to donate tissue. Sometimes, especially in clinical contexts, there're just more urgent things to be done than asking people for their consent for the tissue to be used. Sometimes ethics committees impose very rigorous standards with regard to consent for tissue research and with regard to research ethics on tissue. And in some cases, it is unclear what kind of consent is needed in the first place. And the topic of consent is very closely related to the notion of autonomy. What is autonomy? In the most general sense, autonomy refers to the notion of self-government or self-determination. When we talk about the autonomy of nations, then we mean literally the ability of a nation to govern itself and to be free from interference from others. In the medical domain, autonomy typically refers to individual autonomy, so the autonomy of individual people. And there are two main reasons for this. One reason is that, of course, in medicine we deal with bodies. And the people in those bodies need to be able to decide what happens to their bodies and how their physical integrity is being affected. The other reason is that, especially in Western thought, there's always been a very strong emphasis on individual autonomy rather than more relational ways of understanding personhood. So this accounts for a particularly strong focus on individual autonomy in the medical domain, which some bioethicists see as problematic. It is also important to note that autonomy is not an absolute principle. And we know that from everyday life. We also know it from the law. We cannot murder someone as an expression of our own autonomy. Every society in the world imposes limits to personal autonomy and individual autonomy. But as the image in this slide shows, it is not only when the well being of others is concerned that the autonomy of people can be constrained but sometimes also to protect ourselves or to protect something like the public good in this image here, our autonomy is constrained for the sake of our own safety and security. So this is something that is not unusual in other domains of our lives. And, of course, it also finds an expression in medicine.
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The principle of solidarity and its relevance for tissue research

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