Ethical and psychosocial issues raised by the artificial pancreas

Research team

Ariane Quintal (Pragmatic Health Ethics Research Unit, Université de Montréal); Virginie Messier, MSc (Metabolic Diseases Research Unit); Rémi Rabasa-Lhoret, MD, PhD (Metabolic Diseases Research Unit, Université de Montréal); Eric Racine, PhD (Pragmatic Health Ethics Research Unit, Université de Montréal, McGill University)

Funding

Canadian Institutes of Health Research (CIHR); Fonds de recherche du Québec – Santé (FRQ-S); National Institute of Diabetes and Digestive and Kidney Diseases, NIH

The artificial pancreas (AP) is a portable medical technology in development that aims to automate the management of type 1 diabetes (T1D). The objective of this project is to identify and characterize the ethical and psychosocial issues that will be raised by the AP once it will be integrated into clinical practice. An ethical and critical analysis of the clinical, psychosocial and technical issues raised by the AP that are documented in the scientific literature was initially conducted. A thematic and qualitative analysis was then performed on the content of sixteen semi-structured interviews with people with T1D which explored their perspectives on various issues raised by the AP.

This project is a collaboration with the Metabolic Diseases Research Unit of the IRCM, directed by Dr Rémi Rabasa-Lhoret.

The ethical issues identified through these theoretical and empirical analyses pertain to confidentiality and security, control and agency, public and private coverage, fairness of patient selection, personal identity, relationships, and consent to participating to a research protocol. These ethical issues will influence patient satisfaction and AP update and success and should therefore be taken into account in the development of the AP and of clinical practice guidelines and coverage policies.

Publications

Quintal, A., Messier, V., Rabasa-Lhoret, R., & Racine, E. People with type 1 diabetes’ appreciation of the benefits, the inconveniences and the design of the artificial pancreas, in preparation.

Quintal, A., Messier, V., Rabasa-Lhoret, R., & Racine, E. A qualitative study of people with type 1 diabetes’ perspectives on ethical and psychosocial issues raised by the artificial pancreas, in preparation.

Quintal, A., Messier, V., Rabasa-Lhoret, R., & Racine, E. (2018) A critical review and analysis of ethical issues associated with the artificial pancreas. Diabetes & Metabolism, in revision, Diabetes & Metabolism [epub ahead of print.]

Racine, E., Quintal, A., & Sample, M. (2017). Neuroessentialism in discussions about the impact of closed-loop technologies on agency and identity. AJOB Neuroscience, 8(2), 81–83.