Consent to the publication of patient information
http://www.100md.com
《英国医生杂志》
EDITOR—We welcome the views of the BMJ ethics committee.1 In an article for the Journal of Medical Ethics we drew attention to some of the obstacles to gaining consent for publication of case material in ethics.2 We also reviewed the policy of several general medical and specialist ethics journals and found that many, including the Journal of Medical Ethics, gave no instructions on confidentiality.
Given the amount of case material that is used in medical ethics, this is a serious problem that editors may be addressing in any one of several ways: editors recognise the problems highlighted both in our article and in this one and exercise discretion on what to publish; editors do not think that issues of confidentiality are raised when (apparently) anonymised case studies are used; editors have not given sufficient thought to the matter and have no policy; or, editors did not recognise the issue. We were pleased to read that the BMJ recognises the problem and the need for editorial discretion in difficult cases.
Two issues are not addressed in the article by Singer.
Firstly, it may not be possible to anonymise a case when the relevant ethical issues tend to make it unique. To cover this possibility, it may be worth revising BMJ policy point 3 (ii) to add the public interest in debating important ethical issues to the existing two criteria of clinical lesson or public health.
Secondly, as Newson notes (previous letter),3 the article makes no reference to the problems of gaining consent for those who are unable to consent for themselves. In our paper, we pointed out that publication is rarely in the patient's own interest (although involving an ethicist in discussions about the patient might be),2 so that it is difficult to see the grounds on which consent could be given—except perhaps that it is not against the interests of the patient.
Finally, on the question of reporting mistakes, here the issue might not just be one of the patient's consent. What of others involved? What if the mistake was not made by the person hoping to publish the article but by a colleague or associate? In such cases, should the author gain the consent of other relevant parties? If not, why not? And if not, could the principles for not gaining consent be applied to other cases—for example, those where the patient does not wish to give consent?
Heather Draper, senior lecturer biomedical ethics
University of Birmingham, Birmingham B15 2TT h.draper@bham.ac.uk
Wendy Rogers, associate professor medical ethics and health law
Department of Medical Education, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
Competing interests: None declared.
References
Singer PA. Consent to the publication of patient information. BMJ 2004;329: 566-8. (4 September.)
Rogers WA, Draper H. Confidentiality and the ethics of medical ethics. J Med Ethics 2003;29: 220-4.
Newson AJ. What about incompetent patients? bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7465/566#73435 (accessed 7 Oct 2004).
Given the amount of case material that is used in medical ethics, this is a serious problem that editors may be addressing in any one of several ways: editors recognise the problems highlighted both in our article and in this one and exercise discretion on what to publish; editors do not think that issues of confidentiality are raised when (apparently) anonymised case studies are used; editors have not given sufficient thought to the matter and have no policy; or, editors did not recognise the issue. We were pleased to read that the BMJ recognises the problem and the need for editorial discretion in difficult cases.
Two issues are not addressed in the article by Singer.
Firstly, it may not be possible to anonymise a case when the relevant ethical issues tend to make it unique. To cover this possibility, it may be worth revising BMJ policy point 3 (ii) to add the public interest in debating important ethical issues to the existing two criteria of clinical lesson or public health.
Secondly, as Newson notes (previous letter),3 the article makes no reference to the problems of gaining consent for those who are unable to consent for themselves. In our paper, we pointed out that publication is rarely in the patient's own interest (although involving an ethicist in discussions about the patient might be),2 so that it is difficult to see the grounds on which consent could be given—except perhaps that it is not against the interests of the patient.
Finally, on the question of reporting mistakes, here the issue might not just be one of the patient's consent. What of others involved? What if the mistake was not made by the person hoping to publish the article but by a colleague or associate? In such cases, should the author gain the consent of other relevant parties? If not, why not? And if not, could the principles for not gaining consent be applied to other cases—for example, those where the patient does not wish to give consent?
Heather Draper, senior lecturer biomedical ethics
University of Birmingham, Birmingham B15 2TT h.draper@bham.ac.uk
Wendy Rogers, associate professor medical ethics and health law
Department of Medical Education, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
Competing interests: None declared.
References
Singer PA. Consent to the publication of patient information. BMJ 2004;329: 566-8. (4 September.)
Rogers WA, Draper H. Confidentiality and the ethics of medical ethics. J Med Ethics 2003;29: 220-4.
Newson AJ. What about incompetent patients? bmj.com 2004. http://bmj.bmjjournals.com/cgi/eletters/329/7465/566#73435 (accessed 7 Oct 2004).