Privacy, Confidentiality, And Health Research PDF
Preview Privacy, Confidentiality, And Health Research
Privacy, Confidentiality, and Health Research The potential of the e-health revolution, increased data sharing and interlinking, research biobanks, translational research, and new tech- niques such as geolocation and genomics to advance human health is immense. For the full potential to be realized, though, privacy and confidentiality will have to be carefully protected. Problematically, manyconventionalapproachestosuchpivotalmattersasconsent,iden- tifiability, safeguarding, security, and the international transfer of data and biospecimens are inadequate. The difficulties are aggravated in manycountriesbythefactthatresearchactivitiesarehobbledbythickets oflaws,regulations,andguidancethatserveneitherresearchnorprivacy well.Thechallengesarebeingheightenedbytheincreasinguseofbio- specimens,andbytheglobalizationofresearchinaworldthathasnot globalizedprivacyprotection.Drawingonexamplesfrommanydevel- opedcountries andlegaljurisdictions, WilliamLowrancecritiques the issues,summarizesvariousethics,policy,andlegalpositions(andrevi- sions underway), describes innovative solutions, provides extensive references,andsuggestswaysforward. Dr.WilliamW.Lowranceisaconsultantinhealthresearchpolicyand ethics,basedinLaGrandeMotte,France.AfterearningaPh.D.from The Rockefeller University in the life sciences with a concentration in organicchemistry,heshiftedhisattentiontothesocialaspectsofscience, technology, and medicine. He has been a faculty member or fellow, teachingandconductingresearchonhealthpolicy,environmentalpol- icy, and risk decisionmaking, at Harvard, Stanford, and Rockefeller Universities. He has served as the Director of the Life Sciences and Public Policy Program of Rockefeller University, and as the Executive Director of the International Medical Benefit/Risk Foundation, head- quarteredinGeneva.HisbooksincludeOfAcceptableRisk:Scienceand the Determination of Safety and Modern Science and Human Values. In recentyearshehasfocusedontheissuesofprivacyandconfidentiality inhealthresearch,andhechairedtheadvisorycommitteethatdrafted theEthicsandGovernanceFrameworkofUKBiobank. CambridgeBioethicsandLaw ThisseriesofbookswasfoundedbyCambridgeUniversityPresswithAlexander McCall Smith as its first editor in 2003. It focuses on the law’s complex and troubled relationship with medicine across both the developed and the developing world. In the past twenty years, we have seen in many countries increasingresorttothecourtsbydissatisfiedpatientsandagrowinguseofthe courts to attempt to resolve intractable ethical dilemmas. At the same time, legislaturesacrosstheworldhavestruggledtoaddressthequestionsposedby both the successes and the failures of modern medicine, while international organizationssuchastheWHOandUNESCOnowregularlyaddressissuesof medicallaw. Itfollowsthatwewouldexpectethicalandpolicyquestionstobeintegralto theanalysisofthelegalissuesdiscussedinthisseries.Theseriesrespondstothe highprofileofmedicallawinuniversities,inlegalandmedicalpractice,aswell asinpublicandpoliticalaffairs.Weseektoreflecttheevidencethatmanymajor health-related policy debates in the UK, Europe and the international community over the past two decades have involved a strong medical law dimension. With that in mind, we seek to address how legal analysis might have a transjurisdictional and international relevance. Organ retention, embryonic stem cell research, physician-assisted suicide and the allocation of resources to fund health care are but a few examples among many. The emphasis of this series is thus on matters of public concern and/or practical significance.Welookforbooksthatcouldmakeadifferencetothedevelopment of medical law and enhance the role of medico-legal debate in policy circles. Thatisnottosaythatwelackinterestintheimportanttheoreticaldimensionsof the subject, but we aim to ensure that theoretical debate is grounded in the realitiesofhowthelawdoesandshouldinteractwithmedicineandhealthcare. SeriesEditors ProfessorMargaretBrazier, UniversityofManchester ProfessorGraemeLaurie, UniversityofEdinburgh ProfessorRichardAshcroft,QueenMary, UniversityofLondon ProfessorEricM.Meslin, IndianaUniversity Marcus Radetzki, Marian Radetzki, Niklas Juth Genes and Insurance: Ethical,LegalandEconomicIssues Ruth Macklin Double Standards in Medical Research in Developing Countries DonnaDickenson PropertyintheBody:FeministPerspectives MattiHäyry,RuthChadwick,VilhjálmurÁrnason,GardarÁrnason The EthicsandGovernanceofHumanGeneticDatabases:EuropeanPerspectives Ken Mason The Troubled Pregnancy: Legal Wrongs and Rights in Reproduction DanielSperling PosthumousInterests:LegalandEthicalPerspectives KeithSyrett Law,LegitimacyandtheRationingofHealthCare AlastairMaclean Autonomy,InformedConsentandtheLaw:ARelational Change Heather Widdows, Caroline Mullen The Governance of Genetic Information:WhoDecides? DavidPrice HumanTissueinTransplantationandResearch MattiHäyry RationalityandtheGeneticChallenge:MakingPeopleBetter? Mary Donnelly Healthcare Decision-Making and the Law: Autonomy, CapacityandtheLimitsofLiberalism Anne-Maree Farrell, David Price and Muireann Quigley Organ Shortage:Ethics,LawandPragmatism Sara Fovargue Xenotransplantation and Risk: Regulating a Developing Biotechnology JohnCoggon WhatMakesHealthPublic?:ACriticalEvaluationofMoral, Legal,andPoliticalClaimsinPublicHealth MarkTaylor GeneticDataandtheLaw:ACriticalPerspectiveonPrivacy Protection Anne-Maree Farrell The Politics of Blood: Ethics, Innovation and the RegulationofRisk Stephen Smith End-of-Life Decisions in Medical Care: Principles and PoliciesforRegulatingtheDyingProcess MichaelParker EthicalProblemsandGeneticsPractice WilliamW.Lowrance Privacy,Confidentiality,andHealthResearch fi Privacy, Con dentiality, and Health Research cambridge university press Cambridge,NewYork,Melbourne,Madrid,CapeTown, Singapore,SãoPaulo,Delhi,MexicoCity CambridgeUniversityPress TheEdinburghBuilding,CambridgeCB28RU,UK PublishedintheUnitedStatesofAmericabyCambridgeUniversityPress, NewYork www.cambridge.org Informationonthistitle:www.cambridge.org/9781107020870 ©WilliamW.Lowrance2012 Thispublicationisincopyright.Subjecttostatutoryexception andtotheprovisionsofrelevantcollectivelicensingagreements, noreproductionofanypartmaytakeplacewithoutthewritten permissionofCambridgeUniversityPress. Firstpublished2012 PrintedintheUnitedKingdomattheUniversityPress,Cambridge AcataloguerecordforthispublicationisavailablefromtheBritishLibrary LibraryofCongressCataloguinginPublicationdata Lowrance,WilliamW.,1943– Privacy,confidentiality,andhealthresearch/WilliamW.Lowrance. p. ; cm.–(Cambridgebioethicsandlaw) Includesbibliographicalreferencesandindex. ISBN978-1-107-02087-0(hardback) I. Title. II. Series:Cambridgebioethicsandlaw. [DNLM:1. HealthServicesResearch–legislation&jurisprudence. 2. Privacy–legislation&jurisprudence. 3. ComputerSecurity. 4. Confidentiality–ethics. 5. Confidentiality–legislation& jurisprudence. 6. Databases,Factual–legislation&jurisprudence. 7. HealthServicesResearch–ethics.W84.3] 610.285058–dc23 2011053267 ISBN978-1-107-02087-0Hardback CambridgeUniversityPresshasnoresponsibilityforthepersistenceor accuracyofURLsforexternalorthird-partyinternetwebsitesreferredto inthispublication,anddoesnotguaranteethatanycontentonsuch websitesis,orwillremain,accurateorappropriate. To my wonderfully supportive wife, Catherine Couttenier-Lowrance Contents Prefaceandacknowledgments pagexiii 1 Introduction 1 Healthresearchasapublic-interestcause 1 Privacyprotectionasapublic-interestcause 3 Healthdatavulnerability 4 Thechallenges 4 2 Data,biospecimens,andresearch 7 Afewessentialnotions 7 Thee-healthrevolution 10 Dataanddatabases 11 Biospecimencollections 13 Publicresearchresourceplatforms 18 Degreesofsensitivity 18 Dataandbiospecimenownership 22 Whatisresearch,anyway? 24 3 Privacy,confidentiality,safeguards 29 Privacy 29 Confidentiality 33 Safeguards 34 4 Broadprivacyanddataprotectionregimes 35 Theplethoraofcontrols 35 Twosortsofregimes 36 Earlyconcernsaboutcomputersandprivacy 36 TheOECDprivacyprinciples 38 CouncilofEuropeConvention108 40 TheEuropeanstrategy 40 TheUSapproach 47 TheCanadianstrategy 48 Australia,Japan,APEC 49 5 Healthcare,publichealth,andresearchregimes 52 Healthcareandpaymentregimes 52 Publichealthregimes 53 ix
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