Comment by azalemeth | Hacker News Reader

Comment by azalemeth | Hacker News Reader

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> "Suspected patients were isolated using airborne precautions in the designated hospital, Jin Yin-tan Hospital (Wuhan, China), and fit-tested N95 masks and airborne precautions for aerosol-generating procedures were taken.

> This study was approved by the National Health Commission of China and Ethics Commission of Jin Yin-tan Hospital (KY-2020-01.01).

> Written informed consent was waived by the Ethics Commission of the designated hospital for emerging infectious diseases."

In other words, data from every patient they had is reported in this paper, with or without their consent. That includes radiographic imaging, blood and respiratory specimens, including nasal and pharyngeal swabs, bronchoalveolar lavage fluid, sputum, and/or bronchial aspirates.

In a western country, one of the tenants of medical ethics is that, if you have capacity to consent, you can always refuse to give it. In my country, I would be personally liable for assault if I (invasively) collected these samples from patients _without_ their explicit consent.

It must be a terrifying situation to be in: sick, in respiratory distress, and isolated from your family and friends in a large hospital, surrounded only by presumably somewhat scared looking medical professionals wearing tightly fitting face masks. I just hope that patients were _verbally_ asked if they consented to the collection of bronchoscopy-obtained samples for research and hopefully their diagnosis and management: it is an unpleasant procedure that, like many things in medicine, carries a small but non-zero risk of serious injury or death.

Serious this sort of thinking is what will kill hundreds of millions of people. We are not dealing with a couple of stubbed toes or hurt feelings here, but a novel deadly virus that is out of control. This is a war situation.

"A war situation" is precisely when you need this sort of thinking: the modern ethical framework for medical research with interventions is heavily influenced by "The Nuremberg Code". I don't think we need to describe in detail why people thought that code was necessary.

In most of these cases, it is highly unlikely that any significant number of the patients will withhold their consent: so to not ask it is basically saying "we can't be bothered", there's no obvious scientific basis for such a waiver. When patients are incapacitated there are equivalent frameworks which take their personal circumstances into consideration.

There is nothing to suggest that any patient has withheld consent, just that the requirement to get consent in written form was waived. Given how sick these patients were this is reasonable.

Time is of the essence here. If I was put in the situation these researcher are in I would act first and take the risk of being put on trial later. Real ethics means sometimes you have to do more than just follow rules.

Yup. "If you agree please cough in this paper" does not sound like a very smart move.

Isolation measures and obtaining information are clearly important; so too is acting ethically, and I would argue that it is _precisely_ these sort of circumstances that should prompt us to consider this. And, owing to selection bias in the cases presented, the death rate of this coronavirus is likely far lower than hyped.

Wow this is the first I've heard of the infection and death rate being 'lower than hyped'.

I do believe it's troubling times for everyone near this virus and we need as much information of the virus as possible. This is going past a regular 'patient confidentiality' line and into a 'prevent a possible disaster from occurring by getting on top of it soon'.

> Wow this is the first I've heard of the infection and death rate being 'lower than hyped'.

GP only said the death rate was lower (which necessarily means the infection rate is higher, not lower, assuming all the deaths used in the reported rate are real deaths associated with the disease of concern.)

Nothing about this is a war situation. This just reads like reactionary fear mongering.

Nothing indeed; besides China having put 20m+ people on lockdown, 5m having fled the cities possibly carrying the virus, it having already reached Europe, the US and Australia, doctors on the ground reporting over 100k infected, and the fatality count racing past the hundreds. Enjoy your breakfast.

...and exactly how do you know this?

I don't know, Coronaviridae have neither oil nor WMD?

There might be cause for some concern like for any form of disease, but calling it a war is ridiculous and inappropiate to describe the situation. Even a well intentioned reading of the statement leaves much to wish for.

The common cold kills more than 50,000 people a year. 90% of media reports are intentionally worded to dramatize the situation, so I don't think anything warrants this classification with respect to the people deceased.

This reaction is precisely the reason why some might think about restricting information about infections or simliar health hazards to the public.

So you think the Chinese government has put 50 million people into lockdown just to dramatise the situation for some sort of media beat up?

If we are lucky the problem is not as bad as it appears, but so far nothing I have seen suggests this is anything other than very, very serious.

> In a western country, one of the tenants of medical ethics is that, if you have capacity to consent, you can always refuse to give it.

Always? That's just not true.

In the US, the CDC has the power to involuntarily quarantine AND EXAMINE people.

See their page about legal authority: https://www.cdc.gov/quarantine/aboutlawsregulationsquarantin...

Also, one of the relevant laws (https://www.govinfo.gov/content/pkg/USCODE-2011-title42/html...) says this:

>>> (d) Apprehension and examination of persons reasonably believed to be infected

>>> (1) Regulations prescribed under this section may provide for the apprehension and examination of any individual reasonably believed to be infected with a communicable disease in a qualifying stage and (A) to be moving or about to move from a State to another State; or (B) to be a probable source of infection to individuals who, while infected with such disease in a qualifying stage, will be moving from a State to another State. Such regulations may provide that if upon examination any such individual is found to be infected, he may be detained for such time and in such manner as may be reasonably necessary.

Health officials at the state level also have similar powers. Here's a summary of state-level laws: https://www.ncsl.org/research/health/state-quarantine-and-is...

In many cases, the government has various powers like arresting, fining, or jailing people for violating quarantine or entering private property to investigate.

What is terrifying is the thought of treatment of those very patients, and prevention/cure for the rest of the world being held back by selfish concerns like yours. Can’t wait for the new pleghma privacy law!

The concern is not about privacy, but about forced treatment against your will.

That's a big deal, and most countries have strict law in place to stop it happening in most situations. There are some exceptions for people who are unable to make that choice, but this is limited to people who are not conscious, or who have severe learning disability, or who are currently severely mentally ill.

How exactly did we go from a scientific paper waivering requirements to use patient data, to forced treatment? I’m lost.

Because bronchoalveolar lavage, one of many procedures used here, is an invasive medical procedure that has no purpose other than to obtain information for diagnosis or scientific research. A small endescope is passed down the trachea, and part of the lung tissue irrigated with fluid, and the fluid (now containing cellular detritis) analysed. It is intensely uncomfortable if performed without sedataion and bronchoscopy is typically performed under heavy sedataion as a result. All of these facts carry risk -- risks which, under international law, the patient has to consent to.

It's truly amazing how you fail to see the forrest for not even a tiny bush

You can only do that in a solid dictatorship. That is also true for the wide reaching quarantines.

While some might be scared that much that they approve of these measures, I am just glad not to live in China.

As we see with Vaccines, sometimes prioritizing the good of all is necessarily to keep society from killing itself.

and that's why the West is decaying. Who cares about your morals when there's an epidemic ?

> and that's why the West is decaying. Who cares about your morals when there's an epidemic ?

This kind of bait is not needed on Hacker News. Keep that on reddit or facebook or whatever.

In fairness, the GP is bait too. It's just more thoughtful bait with paragraph breaks. It's basically elegant finger wagging.

Decay of the west bit aside, the parent has a point. Do you freak patients out by getting them to sign things when they are already in quarantine and fearing for their lives? Or do you prioritise research and response?

related: "Conducting Research in Disease Outbreaks" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669128/

But even that document talks about the need to get consent from patients if you're going to use them in medical research.

> Who cares about your morals when there's an epidemic ?

I actually find this to be an interesting ethical dilemma. On one hand, I would probably agree that this specific situation demands a degree of urgency and action such that the rights of an individual should be subjugated, to some extent, to the needs of society as a whole.

On the other hand, if we do accept that there are scenarios where this is a necessary trade-off, who gets to decide which outbreaks qualify? Could someone just invent one to circumvent medical ethics requirements whenever they prove inconvenient?

I guess it's not entirely dissimilar to arguments over limits on freedom of expression in cases where a person's speech can be deemed to cause harm to others (e.g. the canonical yelling fire in a crowded theatre). Where and how do you draw the line?

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