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      Social and Communicative Functions of Informed Consent Forms in East Asia and Beyond

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          Abstract

          The recent research and technology development in medical genomics has raised new issues that are profoundly different from those encountered in traditional clinical research for which informed consent was developed. Global initiatives for international collaboration and public participation in genomics research now face an increasing demand for new forms of informed consent which reflect local contexts. This article analyzes informed consent forms (ICFs) for genomic research formulated by four selected research programs and institutes in East Asia – the Medical Genome Science Program in Japan, Universiti Sains Malaysia Human Research Ethics Committee in Malaysia, and the Taiwan Biobank and the Taipei Medical University- Joint Institutional Review Board in Taiwan. The comparative text analysis highlights East Asian contexts as distinct from other regions by identifying communicative and social functions of consent forms. The communicative functions include re-contact options and offering interactive support for research participants, and setting opportunities for family or community engagement in the consent process. This implies that informed consent cannot be validated solely with the completion of a consent form at the initial stage of the research, and informed consent templates can facilitate interactions between researchers and participants through (even before and after) the research process. The social functions consist of informing participants of possible social risks that include genetic discrimination, sample and data sharing, and highlighting the role of ethics committees. Although international ethics harmonization and the subsequent coordination of consent forms may be necessary to maintain the quality and consistency of consent process for data-intensive international research, it is also worth paying more attention to the local values and different settings that exist where research participants are situated for research in medical genomics. More than simply tools to gain consent from research participants, ICFs function rather as a device of social communication between research communities and civic communities in liaison with intermediary agents like ethics committees, genetic counselors, and public biobanks and databases.

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          Enduring and emerging challenges of informed consent.

          The author summarizes emerging standards for informed consent as the underpinning of ethical research in humans.
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            Improvement of informed consent and the quality of consent documents.

            Guidelines on informed consent intend to protect patients and promote ethical research conduct. To give informed consent, individuals should understand the purpose, process, risks, benefits, and alternatives to research (or a proposed clinical intervention) and make a free, voluntary decision about whether to participate. Many participants have incomplete understanding of various features of clinical trials. Issues associated with the length, format, and language of documents for written informed consent are common. Here, we analyse the written consent form, particularly in the context of clinical research, and the discussions that take place between clinician or investigator and patient. We review strategies to improve consent forms, particularly the use of plain language. Recommendations are made on discussions between investigator and patient to improve participant comprehension and satisfaction with the informed-consent process.
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              Taiwan Biobank: a project aiming to aid Taiwan's transition into a biomedical island.

              Essentially, the term 'biobank' can be defined in different ways. Taking the UK Biobank's experience as the main example, the Taiwan Biobank aims to collect the DNA of a large group of people on the population base and track their health and lifestyle for at least 10 years. It is hoped that the information collected, regarding the mechanisms underlying how genes and environmental factors interact with each other to make us ill, will benefit the society in various ways, including the exploration of a new generation of treatments, support to preventive medicine discovery and also the possible benefits for the promotion of evolving public health-related industries in Taiwan. However, the involvement of large-scale population base gene data collection also triggered serious ethical, legal and social issues. In Taiwan, the challenge is even more serious than for any other biobanking experiences that have occurred previously. Among all the ethical, legal and social issues, the convergence of aboriginal people protection provided under Taiwan's Constitution imposes on the research team an obligation to create an innovative Ethical & Legal Governance Framework adaptable to the unique social background of Taiwan, including a workable public consultation/communication mechanism. In early 2005, the creation of the 'Taiwan Biobank' has been included as a part of Taiwan's strategic development in promoting the country as an island of biomedicine. In this report, the ideology, the goals and special features, government strategy, visions and, in particular, the ethical, legal and social issue planning of the Taiwan Biobank will be briefly introduced and reviewed.
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                Author and article information

                Contributors
                Journal
                Front Genet
                Front Genet
                Front. Genet.
                Frontiers in Genetics
                Frontiers Media S.A.
                1664-8021
                20 July 2017
                2017
                : 8
                : 99
                Affiliations
                [1] 1Graduate School of Medicine, Osaka University Suita, Japan
                [2] 2Division of Human Biology, School of Medicine, International Medical University Kuala Lumpur, Malaysia
                [3] 3Human Research Ethics Committee, Universiti Sains Malaysia Health Campus Kubang Kerian, Malaysia
                [4] 4Institute of European and American Studies, Academia Sinica Taipei, Taiwan
                Author notes

                Edited by: Yann Joly, McGill University, Canada

                Reviewed by: Judy Illes, University of British Columbia, Canada; Bettina Bock Von Wülfingen, Humboldt University of Berlin, Germany

                *Correspondence: Go Yoshizawa, go@ 123456eth.med.osaka-u.ac.jp

                This article was submitted to ELSI in Science and Genetics, a section of the journal Frontiers in Genetics

                Article
                10.3389/fgene.2017.00099
                5517404
                52804f51-f7a7-4e9a-ae57-ba5b1d43ef0c
                Copyright © 2017 Yoshizawa, Sasongko, Ho and Kato.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 08 May 2017
                : 05 July 2017
                Page count
                Figures: 0, Tables: 1, Equations: 0, References: 111, Pages: 12, Words: 0
                Funding
                Funded by: Ministry of Education, Culture, Sports, Science and Technology 10.13039/501100001700
                Award ID: 221S0002
                Funded by: Japan Society for the Promotion of Science 10.13039/501100001691
                Award ID: S16098
                Categories
                Genetics
                Original Research

                Genetics
                medical genomics,consent documents,group consent,family consent,community engagement
                Genetics
                medical genomics, consent documents, group consent, family consent, community engagement

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