The Social Determinants of ‘Health’ of Embryos: Practices, Purposes, and Implications

An increasing focus on the biomedical determinants of the health of embryos and fetuses is resulting from new technical possibilities, clinical considerations and research purposes (Nisker and White, 2005), but also from social factors, and for a variety of reasons. An exploration of the determinants of health of embryos, just as an exploration of the determinants of child or adult health, must take into consideration traditional social determinants, including those related to the consequences of poverty, such as poor nutrition and toxic environments (World Health Organization, 1948; Wilkinson and Marmot, 2003; Raphael, 2004), but also laws, policies and institutions, which are also social determinants of health (Wilkinson and Marmot, 2003)

The Social Determinants of ‘Health’ of Embryos: Practices, Purposes, and Implications

An increasing focus on the biomedical determinants of the health of embryos and fetuses is resulting from new technical possibilities, clinical considerations and research purposes (Nisker and White, 2005), but also from social factors, and for a variety of reasons. An exploration of the determinants of health of embryos, just as an exploration of the determinants of child or adult health, must take into consideration traditional social determinants, including those related to the consequences of poverty, such as poor nutrition and toxic environments (World Health Organization, 1948; Wilkinson and Marmot, 2003; Raphael, 2004), but also laws, policies and institutions, which are also social determinants of health (Wilkinson and Marmot, 2003)

Implications of the concept of minimal risk in research on informed choice in clinical practice

The concept of a minimal risk threshold in research, beneath which exception to informed consent and ethics review processes may occur, has been codified for over 30 years in many national research regulations and by the Council for International Organizations of Medical Sciences. Although minimal risk in research constitutes one of the criteria for allowing waiver of informed consent or modification to the consent process and a large body of literature exists, discussion of a minimal risk threshold in clinical practice has not occurred. One reason for lack of discussion may be that implicit consent is accepted for a wide range of routine clinical practices. Extending the role of minimal risk in research to clinical practice might assist clinicians in identifying circumstances for which implicit consent is indeed sufficient and circumstances in which it is not. Further, concepts from minimal risk in research might assist clinicians regarding when information provision in health promotion is required. We begin by reviewing concepts in both minimal risk in research and informed choice in clinical practice. We then explore how a clinical minimal risk concept may clarify recommendations for information provision in clinical practice and support the patient\u27s informed choice regarding therapeutic and diagnostic procedures and also health promotion. Given that clinical practice involves a broad scope of health information, professional practice guidelines on information provision based on the application of the minimal risk threshold in research could be developed to guide clinicians in what information must be provided to their patients