Antonio Casado da Rocha

Alternative Consent Models for Biobanks: The New Spanish Law on Biomedical Research

This article provides an overview of recent contributions to the debate on the ethical use of previously collected biobank samples, as well as a country report about how this issue has been regulated in Spain by means of the new Biomedical Research Act, enacted in the summer of 2007. By contrasting the Spanish legal situation with the wider discourse of international bioethics, we identify and discuss a general trend moving from the traditional requirements of informed consent towards new models more favourable to research in a post-genomic context.

Wired for autonomy

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Towards a Comprehensive Concept of Patient Autonomy

The article by Naik and colleagues (2009) provides a sound argument for introducing executive autonomy into bioethics. Indeed, the management of chronic disease requires a more encompassing account of autonomy than that offered by the standard accounts associated with modern tertiary care hospitals and the treatment of acute diseases. At least in Spain, the birth of bioethics took place in such an environment, and its initial focus was therefore on principles designed to help with fast, life-or-death, decision-making. By the end of the 20th century, however, a higher life expectancy rate and other social and cultural factors have turned the attention of institutionalized bioethics to chronic disease, shifting the focus from emergency medicine to primary, long-term care. Authors such as Diego Gracia have argued that this shift has profound consequences in the way we should think about the relationship between traditional principles of bioethics and other values (Casado 2008a, 160– 164). This shift leads to an understanding of health and disease as intrinsically normative concepts, which in turn contributes to blurring the distinction between facts and values. As a result, contemporary bioethics is currently immersed in a process of expansion that challenges traditional models of patient autonomy and physician responsibility (Casado 2008b). In this commentary I aim to argue that the reconceptualization by Naik and colleagues (2009) should be further expanded in order to supplement its decisional and executive components with a particular approach to other aspects of patient autonomy. I do not question their emphasis on the importance of taking into account executive autonomy, as this is an issue in which I see the build-up of a general consensus. Although Naik and colleagues claim that the executive component has been “greatly underappreciated” in “recent bioethics literature”, it is not so difficult to find evidence suggesting otherwise. They provide, as an example, a PubMed search producing only two citations. But PubMed mainly contains references to journal articles in the life sciences area, with a clear focus on biomedicine, and bioethics is a cross-discipline field. Similar searches in other databases produce more results. For example, when I entered the same terms used by Naik and colleagues (2009) (consent AND autonomy AND executive function), the Project MUSE search engine reported 231 hits. Many of them are irrelevant to our discussion, but the first one was a article by Joel Anderson and Warren Lux (2004) that I consider to be of the utmost importance.

Biobank Governance in Spain: From the Autonomy of Research Ethics Committees to the Autonomy of Lay People

According to Time Magazine, biobanks are one of the “10 ideas changing the world right now” (Park in Biobanks (10 Ideas Changing the World Right Now) 2009), nothing less. Collecting biological material for research is not a novel thing, but developments in genomics have renewed interest in establishing new biobanks, as well as increasing access to existing collections.

Autonomy Beyond the Brain: What Neuroscience Offers to a More Interactive, Relational Bioethics

In our research group on the philosophy of biology (www.ehu.es/ias-research), we are developing an understanding of autonomy as the maintenance of an identity over time by means of interaction with...