Research is a duty for health professionals and in the best interest of patients in times of a pandemic: Empirical exploration and ethical implications of the Research Ethics in Times of Pandemic (RESET-PAN) survey

Abstract

Background

The COVID-19 pandemic has led to an unprecedented global mobilization of biomedical research, especially as some countries have experienced a shortage of medical resources. Bioethicists have proposed to question the entanglement of care and research in the event of a pandemic. Above all, research could be seen as a moral duty for professionals but also as the best interest of patients in a context of uncertainty. In addition, participating in biomedical research could be a decisive factor in the prioritization decision in the event of a shortage of medical resources. However, these proposals from American bioethicists have not been submitted for approval by French health professionals.

Methodology

The Research Ethics Committee of the University Hospital of Bordeaux, France, has conceived a survey exploring the opinion of health professionals of the institution concerning the current French regulations on research ethics in the pandemic, on the intertwining of care and research during a pandemic, and concerning proposals on reciprocity between care and research in a context of a global pandemic.

Results

Out of 439 responses collected, the main results showed that a large majority of healthcare professionals agreed that research constitutes an ethical duty for professionals but must also be considered as the best interests of patients in the event of pandemic (90.6% and 75.5% respectively). Health professionals also considered a possible reciprocal commitment of patients through their inclusion in biomedical research since they benefit from care in situations of scarcity of medical resources (from 55.6% to 86.2% depending on the type of study). Contrary to recommendations, the respondents were mostly opposed to the prioritization of patients included in biomedical research in the event of a prioritization process for the allocation of medical resources (64.7% against the use of this criterion in triage decisions).

Discussion

This survey showed that health professionals of our institution were ready to consider a paradigm shift in the way care and research could be considered in times of a pandemic of an emerging infectious agent, and in a context of tension for access to medical resources. A deeper entanglement of care and research needs careful consideration given the possible implications for consent processes and the ethical review of research protocols. In addition, it involves the preparedness and coordination of health professionals and health systems on a large scale.

Conclusion/Perspectives

Additional studies, including in-depth explorations with stakeholders, especially representatives of patients and society, are needed to better understand how a pandemic context should induce major adaptations in the way of considering the interaction between care and research.