Informed consent and registry-based research - the case of the Danish circumcision registry

BackgroundResearch into personal health data holds great potential not only for improved treatment but also for economic growth. In these years many countries are developing policies aimed at facilitating such research often under the banner of ‘big data’. A central point of debate is whether the secondary use of health data requires informed consent if the data is anonymised. In 2013 the Danish Minister of Health established a new register collecting data about all ritual male childhood circumcisions in Denmark. The main purpose of the register was to enable future research into the consequences of ritual circumcision.DiscussionThis article is a study into the case of the Danish Circumcision Registry. We show that such a registry may lead to various forms of harm such as 1) overreaching social pressure, 2) stigmatization, 3) medicalization of a religious practice, 4) discrimination, and 5) polarised research, and that a person may therefore have a strong and legitimate interest in deciding whether or not such data should be collected and/or used in research. This casts doubt on the claim that the requirement of informed consent could and should be waived for all types of secondary research into registries. We finally sketch a new model of informed consent – Meta consent – aimed at striking a balance between the interests in promoting research and at the same time protecting the individual.SummaryResearch participants may have a strong and legitimate interest in deciding whether or not their data should be collected and used for registry-based research whether or not their data is anonymised.

[1]  William W Lowrance,et al.  Learning from experience: privacy and the secondary use of data in health research , 2002, Journal of health services research & policy.

[2]  Bruce G. Link,et al.  On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. , 1997, Journal of health and social behavior.

[3]  R. Dworkin Life's Dominion: An Argument about Abortion, Euthanasia, and Individual Freedom , 2011 .

[4]  Shalom H. Schwartz,et al.  Value priorities and religiosity in four Western religions. , 1995 .

[5]  D. Gollaher From Ritual to Science: The Medical Transformation of Circumcision in America , 1994 .

[6]  J. Christman,et al.  Liberalism and Individual Positive Freedom , 1991, Ethics.

[7]  Z. Bańkowski Hiding from Humanity: Disgust, Shame and the Law , 2006 .

[8]  C. Holman The impracticable nature of consent for research use of linked administrative health records. , 2001 .

[9]  B. Earp Addressing polarisation in science , 2015, Journal of Medical Ethics.

[10]  I. K. Zola,et al.  Medicine as an Institution of Social Control , 1972, The Sociological review.

[11]  J. Ziman The continuing need for disinterested research , 2002, Science and engineering ethics.

[12]  M. Frisch,et al.  Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark , 2015, Journal of the Royal Society of Medicine.

[13]  Christian S. Crandall,et al.  Aids-Related Stigmatization and the Disruption of Social Relationships , 1992 .

[14]  M. Grønbæk,et al.  Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. , 2011, International journal of epidemiology.

[15]  Geoffrey W. Sutton God Is Not Great: How Religion Poisons Everything , 2007 .

[16]  C. Alessi The God delusion. , 2012, The Health service journal.

[17]  H. Whitehouse Modes of Religiosity: A Cognitive Theory of Religious Transmission , 2004 .

[18]  J. Cassell,et al.  Why we should not seek individual informed consent for participation in health services research , 2002, Journal of medical ethics.

[19]  Harry G. Frankfurt,et al.  The importance of what we care about: Freedom of the will and the concept of a person , 1971 .

[20]  Thomas Ploug,et al.  Pharmaceutical information systems and possible implementations of informed consent - developing an heuristic , 2012, BMC Medical Ethics.

[21]  Thomas Ploug,et al.  Going Beyond the False Dichotomy of Broad or Specific Consent: A Meta-Perspective on Participant Choice in Research Using Human Tissue , 2015, The American journal of bioethics : AJOB.

[22]  A. McMath Infant male circumcision and the autonomy of the child: two ethical questions , 2015, Journal of Medical Ethics.

[23]  Jack V Tu,et al.  Impracticability of informed consent in the Registry of the Canadian Stroke Network. , 2004, The New England journal of medicine.

[24]  R. Bayer Stigma and the ethics of public health: not can we but should we. , 2008, Social science & medicine.

[25]  F. Jotterand,et al.  Can medicalization be good? Situating medicalization within bioethics , 2009, Theoretical medicine and bioethics.

[26]  Peter Conrad,et al.  Medicalization and Social Control , 1992 .

[27]  T. Szasz Routine neonatal circumcision: symbol of the birth of the therapeutic state. , 1996, The Journal of medicine and philosophy.

[28]  Thomas Ploug,et al.  The stigmatization dilemma in public health policy-the case of MRSA in Denmark , 2015, BMC Public Health.

[29]  W. Fetter,et al.  Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision , 2013, Pediatrics.

[30]  Angus Nicoll,et al.  Consent, confidentiality, and the threat to public health surveillance. , 2002, BMJ : British Medical Journal.

[31]  M. Verweij Medicalization as a moral problem for preventative medicine. , 1999, Bioethics.

[32]  C. Holman The impracticable nature of consent for research use of linked administrative health records , 2001, Australian and New Zealand journal of public health.

[33]  Thomas Ploug,et al.  Meta consent: a flexible and autonomous way of obtaining informed consent for secondary research , 2015, BMJ : British Medical Journal.

[34]  L. Carpenter On remedicalisation: male circumcision in the United States and Great Britain. , 2010, Sociology of health & illness.

[35]  Thomas Ploug,et al.  Meta Consent – A Flexible Solution to the Problem of Secondary Use of Health Data , 2016, Bioethics.

[36]  M. Thomson,et al.  Short Changed? the Law and Ethics of Male Circumcision , 2005 .

[37]  Thomas Ploug,et al.  Conflict of interest disclosure and the polarisation of scientific communities , 2015, Journal of Medical Ethics.

[38]  R. Saunders,et al.  Best Care at Lower Cost: The Path to Continuously Learning Health Care in America , 2013 .

[39]  F. Schoeman,et al.  Privacy and Social Freedom , 1992 .

[40]  Thomas Ploug,et al.  Routinisation of informed consent in online health care systems , 2015, Int. J. Medical Informatics.

[41]  J. Gatt God is not great, how religion poisons everything , 2015 .

[42]  Thomas Ploug,et al.  Informed consent and routinisation , 2012, Journal of Medical Ethics.

[43]  V. Sharpe Science, bioethics, and the public interest: on the need for transparency. , 2002, The Hastings Center report.

[44]  C. Verity,et al.  Education and debate: Consent, confidentiality, and the threat to public health surveillance * Commentary: Don't waive consent lightly---involve the public , 2002 .

[45]  Frank van Kolfschooten Conflicts of interest: Can you believe what you read? , 2002, Nature.