LETTERS * CORRESPONDANCE
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors ofaccepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait et& presente ailleurs pour publication ou deja paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont dOtruites. Les lettres retenues peuvent etre abre,gdes ou faire l'objet de modifications d'ordre redactionnel.
Guidelines on ethical and legal considerations in anonymous unlinked HIV seroprevalence research T| a he arguments of Dr. David Coburn and the response of Ms. Kimberly Elmslie
(Can Med Assoc J 1991; 144: 1603-1604) are not just seriously flawed: they miss the fundamental ethical point of this discussion. There is no dispute on informed consent to testing as an expression of autonomy. The principle of confidentiality applies to the results of such tests, although there is disagreement as to its application when other people's rights are involved. But under discussion here is the right of patients to control and determine the use to which the surplus 1418
CAN MED ASSOC J 1991; 145 (I 1)
portion of a specimen may be put when the purpose for which it was taken has been fulfilled - to govern, in fact, what happens to their biologic waste material. The surplus of a blood specimen is just that - waste material. The rights of the person from whom it has been obtained end at this point, and the specimen becomes the responsibility of the community, to be disposed of in accordance with hygiene and decency. An ethical community regards waste as a resource and, indeed, should use that term. If it can be recycled for further use or processed to yield energy, then this should be done. Surplus blood specimens can be processed to yield information that is of vital use to the community as a whole; the current flood of reports on the spread of human immunodeficiency virus (HIV) in the community testifies to this. No one retains the right to determine, limit or control the use to which their personal waste is put. The surplus blood specimen, unlinkable and anonymous, is precisely the same in moral terms as an empty metal can or used newspaper. Emotional reactions to blood as a part of one's physical being and to acquired immunodeficiency syndrome (AIDS) as a dangerous disease associated with homosexuality and drug addiction cannot be allowed to obscure or confuse rational thinking. For many years surplus blood specimens have been used to track the progress of other diseases through the community and to establish normal values of blood components, with never a whisper of protest. It is the overtones of HIV infection and AIDS that have raised objections. I find
these illogical, without moral basis and incomprehensible. Harry E. Emson, MD Professor of pathology Royal University Hospital Saskatoon, Sask.
[Dr. Coburn responds.] Dr. Emson's contentions are flawed. He implicitly assumes that all purposes to which waste products can be put are equally good. However, I argue that consideration of what is a good use of waste products leads to support of my position that the public and patients have to be involved in ethical decision-making. Surely we can imagine instances in which there is an obligation to obtain consent for the use of biologic waste productsfor example, if they were used to test the efficacy of nerve gas or for other military purposes, for profit or for purposes that are against the religious or moral codes of particular individuals or groups. If there are some instances in which we agree that surplus products should not be used, then we are drawn into an argument about precisely which uses should be allowed and are to the public benefit. It might be claimed that the examples given are rather farfetched or are not unalloyed medical reasons and that the use of blood products to trace the progress of HIV infection is necessary, useful and in the public interest. That may or may not be true, but it brings us full circle back to the issue of precisely who is to decide what is in the public interest. Individuals and groups have the right to participate in making ethical decisions (such as what is LE
:rD;CEMBRE 1991
1
We will consider for publication only letters submitted in duplicate, printed in letterquality type without proportional spacing and not exceeding 450 words. All the authors must sign a covering letter transferring copyright. Letters must not duplicate material being submitted elsewhere or already published. We routinely correspond only with authors ofaccepted letters. Rejected letters are destroyed. Accepted letters are subject to editing and abridgement.
Seules peuvent etre retenues pour publications les lettres recues en double dont la longueur n'excede pas 450 mots. Elles doivent etre mecanographiees en qualite "correspondance" sans espacement proportionnel. Tous les auteurs doivent signer une lettre d'accompagnement portant cession du copyright. Les lettres ne doivent rien contenir qui ait et& presente ailleurs pour publication ou deja paru. En principe, la redaction correspond uniquement avec les auteurs des lettres retenues pour publication. Les lettres refusees sont dOtruites. Les lettres retenues peuvent etre abre,gdes ou faire l'objet de modifications d'ordre redactionnel.
Guidelines on ethical and legal considerations in anonymous unlinked HIV seroprevalence research T| a he arguments of Dr. David Coburn and the response of Ms. Kimberly Elmslie
(Can Med Assoc J 1991; 144: 1603-1604) are not just seriously flawed: they miss the fundamental ethical point of this discussion. There is no dispute on informed consent to testing as an expression of autonomy. The principle of confidentiality applies to the results of such tests, although there is disagreement as to its application when other people's rights are involved. But under discussion here is the right of patients to control and determine the use to which the surplus 1418
CAN MED ASSOC J 1991; 145 (I 1)
portion of a specimen may be put when the purpose for which it was taken has been fulfilled - to govern, in fact, what happens to their biologic waste material. The surplus of a blood specimen is just that - waste material. The rights of the person from whom it has been obtained end at this point, and the specimen becomes the responsibility of the community, to be disposed of in accordance with hygiene and decency. An ethical community regards waste as a resource and, indeed, should use that term. If it can be recycled for further use or processed to yield energy, then this should be done. Surplus blood specimens can be processed to yield information that is of vital use to the community as a whole; the current flood of reports on the spread of human immunodeficiency virus (HIV) in the community testifies to this. No one retains the right to determine, limit or control the use to which their personal waste is put. The surplus blood specimen, unlinkable and anonymous, is precisely the same in moral terms as an empty metal can or used newspaper. Emotional reactions to blood as a part of one's physical being and to acquired immunodeficiency syndrome (AIDS) as a dangerous disease associated with homosexuality and drug addiction cannot be allowed to obscure or confuse rational thinking. For many years surplus blood specimens have been used to track the progress of other diseases through the community and to establish normal values of blood components, with never a whisper of protest. It is the overtones of HIV infection and AIDS that have raised objections. I find
these illogical, without moral basis and incomprehensible. Harry E. Emson, MD Professor of pathology Royal University Hospital Saskatoon, Sask.
[Dr. Coburn responds.] Dr. Emson's contentions are flawed. He implicitly assumes that all purposes to which waste products can be put are equally good. However, I argue that consideration of what is a good use of waste products leads to support of my position that the public and patients have to be involved in ethical decision-making. Surely we can imagine instances in which there is an obligation to obtain consent for the use of biologic waste productsfor example, if they were used to test the efficacy of nerve gas or for other military purposes, for profit or for purposes that are against the religious or moral codes of particular individuals or groups. If there are some instances in which we agree that surplus products should not be used, then we are drawn into an argument about precisely which uses should be allowed and are to the public benefit. It might be claimed that the examples given are rather farfetched or are not unalloyed medical reasons and that the use of blood products to trace the progress of HIV infection is necessary, useful and in the public interest. That may or may not be true, but it brings us full circle back to the issue of precisely who is to decide what is in the public interest. Individuals and groups have the right to participate in making ethical decisions (such as what is LE
:rD;CEMBRE 1991
1
