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Consent for critical care research after death from COVID-19 : arguments for a waiver

dc.contributor.authorMoodley, Keymanthrien_ZA
dc.contributor.authorAllwood, Brian W.en_ZA
dc.contributor.authorRossouw, T. M.en_ZA
dc.date.accessioned2020-06-09T12:56:11Z
dc.date.available2020-06-09T12:56:11Z
dc.date.issued2020-05-26
dc.identifier.citationMoodley, K., Allwood, B. W. & Rossouw, T. M. 2020. Consent for critical care research after death from COVID-19 : arguments for a waiver. South African Medical Journal, doi:10.7196/SAMJ.2020.v110i7.14918.
dc.identifier.issn2078-5135 (online)
dc.identifier.issn0256-9574 (print)
dc.identifier.otherdoi:10.7196/SAMJ.2020.v110i7.14918
dc.identifier.urihttp://hdl.handle.net/10019.1/108649
dc.descriptionCITATION: Moodley, K., Allwood, B. W. & Rossouw, T. M. 2020. Consent for critical care research after death from COVID-19 : arguments for a waiver. South African Medical Journal, doi:10.7196/SAMJ.2020.v110i7.14918.
dc.descriptionThe original publication is available at http://www.samj.org.za
dc.description.abstractPandemics challenge clinicians and scientists in many ways, especially when the virus is novel and disease expression becomes variable or unpredictable. Under such circumstances, research becomes critical to inform clinical care and protect future patients. Given that severely ill patients admitted to intensive care units are at high risk of mortality, establishing the cause of death at a histopathological level could prove invaluable in contributing to the understanding of COVID-19. Postmortem examination including autopsies would be optimal. However, in the context of high contagion and limited personal protective equipment, full autopsies are not being conducted in South Africa (SA). A compromise would require tissue biopsies and samples to be taken immediately after death to obtain diagnostic information, which could potentially guide care of future patients, or generate hypotheses for finding needed solutions. In the absence of an advance written directive (including a will or medical record) providing consent for postmortem research, proxy consent is the next best option. However, obtaining consent from distraught family members, under circumstances of legally mandated lockdown when strict infection control measures limit visitors in hospitals, is challenging. Their extreme vulnerability and emotional distress make full understanding of the rationale and consent process difficult either before or upon death of a family member. While it is morally distressing to convey a message of death telephonically, it is inhumane to request consent for urgent research in the same conversation. Careful balancing of the principles of autonomy, non-maleficence and justice becomes an ethical imperative. Under such circumstances, a waiver of consent, preferably followed by deferred proxy consent, granted by a research ethics committee in keeping with national ethics guidance and legislation, would fulfil the basic premise of care and research: first do no harm. This article examines the SA research ethics framework, guidance and legislation to justify support for a waiver of consent followed by deferred proxy consent, when possible, in urgent research after death to inform current and future care to contain the pandemic in the public interest.en_ZA
dc.description.urihttp://www.samj.org.za/index.php/samj/article/view/12955
dc.format.extent6 pages
dc.language.isoen_ZAen_ZA
dc.publisherHealth & Medical Publishing Group
dc.subjectCOVID-19 (Disease) -- Research -- Moral and ethical aspects -- South Africaen_ZA
dc.subjectInformed consent (Medical law) -- South Africaen_ZA
dc.titleConsent for critical care research after death from COVID-19 : arguments for a waiveren_ZA
dc.typeArticleen_ZA
dc.description.versionPublisher's version
dc.rights.holderAuthors retain copyright


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