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The Ethics of Clinical Trials: A Child's View

Published online by Cambridge University Press:  01 January 2021

Extract

Until a few years ago, the prevailing view was that children should not be participants in clinical research trials because children were incapable of consenting to such nontherapeutic interventions and are particularly vulnerable to abuse. That view has undergone a significant shift in the last few years, particularly in the context of trials to test the safety and effectiveness of drugs. A number of events facilitated this change, including the widespread off-label distribution of drugs to children and developments in the AIDS epidemic. These social forces have shifted the core ethical question from whether children should be research subjects to when children should be research subjects.

The presumption in favor of including children as research subjects for drug trials has manifested itself primarily through two different reforms: a 1997 federal statute and a set of regulations promulgated by the Food and Drug Administration (FDA) that recently became effective. Together they reflect the view that children deserve the same access to safe and effective therapies as adults.

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Copyright © American Society of Law, Medicine and Ethics 2000

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References

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65 Fed. Reg. at 19,777, col. 1. The most recent version of the document has been submitted for adoption by the countries' regulatory bodies, including the FDA. See International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use, “The ICH Process for Harmonisation of Guidelines” (visited Oct. 31, 2000) <http://www.ifpma.org/ich4.html> (describing Steps 4 and 5). (describing Steps 4 and 5).' href=https://scholar.google.com/scholar?q=65+Fed.+Reg.+at+19,777,+col.+1.+The+most+recent+version+of+the+document+has+been+submitted+for+adoption+by+the+countries'+regulatory+bodies,+including+the+FDA.+See+International+Conference+on+Harmonisation+of+Technical+Requirements+for+Registration+of+Pharmaceuticals+for+Human+Use,+“The+ICH+Process+for+Harmonisation+of+Guidelines”+(visited+Oct.+31,+2000)++(describing+Steps+4+and+5).>Google Scholar
Guidance E11, supra note 74, § 1.1.Google Scholar
See id. §§1.4, 2.6.Google Scholar
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Compare id., with discussion supra Section III.B.3 (discussion of AAP Guidelines).Google Scholar
Guidance E11, supra note 74, § 2.6.1.Google Scholar
See supra note 115 and accompanying text.Google Scholar
Guidance E11, supra note 74, § 2.6.2.Google Scholar
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A similar standard is articulated by the AAP. See AAP Guidelines, supra note 31, at 7 (waiver of assent where participation may be of such benefit that the child's welfare would be significantly jeopardized by failure to provide assent).Google Scholar
See also 45 C.F.R. § 46.408(a) (1999) (waiver permitted “[if] the IRB determines that … [the] procedure involved in the research holds out a prospect of direct benefit that is important to the health or well-being of the children” and is available only in the context of the research ….”Google Scholar
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Compare Commission Report, supra note 33, at 17–19, with 45 C.F.R. § 46.408(c).Google Scholar
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This protection is a variation of 45 C.F.R. § 46.406, but it eliminates references to the subject's disorder or condition since a reference to the subject is unnecessary.Google Scholar
This procedure is a variation on the national review process set forth in 45 C.F.R. § 46.407. See supra note 92 and accompanying text.Google Scholar
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Id. § 46.408 (1999).CrossRefGoogle Scholar
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See supra note 32 and accompanying text.Google Scholar
A similar approach is used in 45 C.F.R. § 46.406: “the intervention or procedure presents experiences to subjects that are reasonably commensurate with those inherent in their actual or expected medical, dental, psychological, social or educational situations. …”Google Scholar
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See discussion supra Section III.B.4.Google Scholar
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Contra Glantz, supra note 1, at 242–44 (recommending that the FDA specifically lay out its position on a number of issues).Google Scholar