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Research on Medical Records without Informed Consent

Published online by Cambridge University Press:  01 January 2021

Extract

Research drawn from data contained in medical records is a common and immensely important means of scientific investigation in epidemiology and health services research. It provides valuable knowledge regarding risk factors for disease, the safety of pharmaceuticals and medical procedures, and the quality of medical care. Electronic information technology has greatly enhanced the capability of conducting research using medical records, but it has also generated increasing concern about invasions of privacy. Both practical and scientific considerations militate against soliciting consent for population-based observational research. Retrospective review of existing medical records, especially with large samples, poses insuperable barriers to locating human subjects in order to obtain their informed consent. When efforts are made to obtain informed consent for prospective research drawn from disease and treatment registries, mounting evidence has accumulated that substantial selection biases are introduced into the data, as those who consent are not necessarily representative of the population of relevant patients.

Type
Independent
Copyright
Copyright © American Society of Law, Medicine and Ethics 2008

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References

Wald, N. et al., “Use of Personal Medical Records for Research Purposes,” BMJ 309, no. 6966 (1994): 14221424; Simon, G. E. et al., “Large Medical Databases, Population-Based Research, and Patient Confidentiality,” American Journal of Psychiatry 157, no. 11 (2000): 1731–1737.CrossRefGoogle Scholar
Black, N., “Secondary Use of Personal Data for Health and Health Services Research: Why Identifiable Data Are Essential,” Journal of Health Services Research & Policy 8, Supplement 1 (2003): 3640.CrossRefGoogle Scholar
Woolf, S. H. et al., “Selection Bias from Requiring Patients to Give Consent to Examine Data for Health Services Research,” Archives of Family Medicine 9, no. 9 (2000): 11111118; Tu, J. V. et al., “Impracticability of Informed Consent in the Registry of the Canadian Stroke Network,” New England Journal of Medicine 350, no. 14 (2004): 1414–1421; Buckley, B. et al., “Selection Bias Resulting from the Requirement for Prior Consent in Observational Research: A Community Cohort of People with Ischaemic Heart Disease,” Heart 93, no. 10 (2007): 1116–1120.CrossRefGoogle Scholar
Protection of Human Subjects, Department of Health and Human Services, Code of Federal Regulations (1991), 45 C. F.R. 46.102 (f).Google Scholar
National Institutes of Health, Office of Human Subjects Research, Nuremberg Code, 1946, available at <http://ohsr.od.nih.gov/guidelines/nuremberg.html> (last visited June 3, 2008).+(last+visited+June+3,+2008).>Google Scholar
The United National International Covenant on Civil and Political Rights, 1966, at Article 7, available at <www.hrweb.org/legal/cpr.html> (last visited June 3, 2008).+(last+visited+June+3,+2008).>Google Scholar
Beauchamp, T. L. and Childress, J. F., Principles of Biomedical Ethics, 5th ed. (New York: Oxford University Press, 2001): at 297.Google Scholar
Gostin, L. O. and Hodge, J. G. Jr., “Personal Privacy and Common Goods: A Framework for Balancing under the National Health Information Privacy Rule,” Minnesota Law Review 86, no. 6 (2002): 1439–79, at 1454.Google Scholar
Id., at 1455.Google Scholar
Id., at 1441.Google Scholar
Feinberg, J., Harm to Self (New York: Oxford University Press, 1986): At 54–55.Google Scholar
Protection of Human Subjects, Department of Health and Human Services, Code of Federal Regulations (1991), 45 C. F. R. 46.116 (d) (2).Google Scholar
Starr, P., “Health and the Right to Privacy,” American Journal of Law & Medicine 25, nos. 2 and 3 (1999): 193201, at 200.Google Scholar
Id., at 201.Google Scholar
Rawls, J., A Theory of Justice, rev. ed. (Cambridge: Harvard University Press, 1999): at 96.Google Scholar
Harris, J., “Scientific Research Is a Moral Duty,” Journal of Medical Ethics 31, no. 4 (2005): 242248.CrossRefGoogle Scholar
Mill, J. S., “On Liberty,” in Utilitarianism, Liberty and Representative Government (London: J. M. Dent, 1971): at 74.Google Scholar
Capron, A. M., “Protection of Research Subjects: Do Special Rules Apply in Epidemiology?” Journal of Clinical Epidemiology 44, Supplement 1 (1991): 81S89S, at 87S.CrossRefGoogle Scholar
Lowrance, W., “Learning From Experience: Privacy and the Secondary Use of Data in Health Research,” Journal of Health Services Research & Policy 8, Supplement 1 (2003): 27.CrossRefGoogle Scholar
Miller, F. G. and Wertheimer, A., “Facing up to Paternalism in Research Ethics,” Hastings Center Report 37, no. 3 (2007): 2434.CrossRefGoogle Scholar
Gostin, L. O., “National Health Information Privacy: Regulations under the Health Insurance Portability and Accountability Act,” JAMA 285, no. 23 (2001): 30153021.CrossRefGoogle Scholar
Kass, N. E. et al., “The use of Medical Records in Research: What Do Patients Want?” Journal of Law, Medicine & Ethics 31, no. 3 (2003): 429433; Willison, D. J. et al., “Patient Consent Preferences for Research Uses of Information and Electronic Medical Records: Interview and Survey Data,” BMJ 326, no. 7385 (2003): 373–337; Robling, M. R. et al., “Public Attitudes towards the Use of Primary Care Patient Record Data in Medical Research without Consent: A Qualitative Study,” Journal of Medical Ethics 30, no. 1 (2004): 104–109; and Damschroder, L. J. et al., “Patients, Privacy, and Trust: Patients' Willingness to Allow Researchers to Access Their Medical Records,” Social Science and Medicine 64, no. 1 (2007): 223–235.CrossRefGoogle Scholar
Miller, F. G. and Wendler, D., “The Relevance of Empirical Research in Bioethics,” Schizophrenia Bulletin 32, no. 1 (2006): 3741.CrossRefGoogle Scholar