From: mjs23x@gmail.com

Ethical issues in microbiome research and medicine 
Rosamond RhodesEmail authorView ORCID ID profile 
BMC Medicine201614:156 
DOI: 10.1186/s12916-016-0702-7©  The Author(s). 2016 
Received: 22 June 2016Accepted: 21 September 2016Published: 12 October 2016 
Open Peer Review reports 
Abstract 

The human microbiome is the collection of bacteria, viruses, and fungi that
live on and in the human organism’s skin, mucosa, and intestinal tract.
Re-examining commonly accepted ethical standards from the perspective of this
new area of research 
provides an opportunity to reassess our current thinking about research
regulations as well as the importance of some principles and distinctions. In
this commentary, I explain ethical issues illuminated by research on the human
microbiome related to 
personal identity, privacy, property, research ethics, public health, and
biobanks. 

Keywords 

Microbiome Ethics Research ethics Public health Biobanks Privacy Property 
Background 

The cohabitation of the human genome and the genomes of the bacteria and
viruses that occupy our skin, mucous membranes, intestinal tract, and other
parts of our bodies together make up the microbiome. In 2007, the National
Institute of Health launched 
the Human Microbiome Project to utilize technological advances to characterize
the microbial communities that inhabit the human body and explore the
relationships between the microbiota and their human hosts, including the
effect that they may have on 
human health and disease, development, physiology, immunity, and nutrition. 

Learning about the microbiome will change how medicine is practiced. It may
also have implications for our social and legal systems and for how we
conceive the ethics of medicine and biomedical research. Therefore, it is
important to identify the ethical,
 legal, and social implications raised by human microbiome research in order
to advise both the scientists engaged in the work and members of society who
will participate in studies and live with the consequences . 

Addressing issues from the vantage point of microbiome research provides a
fresh perspective on who we are, our place in the world, and our
responsibilities to one another. For example, research on the human microbiome
calls for a paradigm shift from 
thinking about germs as enemies that must be hunted and destroyed to thinking
about achieving a healthy microbiotic environment around and within us.
Further, clinicians and investigators will be expanding their focus from
diagnosing individual genetic 
anomalies to developing an understanding of the human genome and its
interactions with the microbiome [1, 2, 3]. In addition, studies to advance
personalized medicine will require broad public participation to provide
sufficient material for biobanks and 
sample banks rather than a small sample of people with a target condition.
Although personhood and identity have never been simple concepts, as we learn
more about ourselves as an amalgam of us and the microbes that live on us and
within us, we will 
rethink our concepts of personal identity and normalcy. Thus, in numerous
ways, learning about the microbiome may shift the moral perspective from a
focus on individual rights and liberties toward a community perspective that
values solidarity. 

Personal identity 

“I” used to be a simple term, and everyone knew what “I” meant. Now,
in light of what we are learning from science, “I” refers to me as a moral
agent, and the subject of my consciousness, and my genotype, and my phenotype,
and my microbiome 
comprised of critters that are not me, many of which come and go. In different
contexts, different concepts of “me” are relevant. Ethically, only some
humans are moral persons, because only some can be held responsible for their
actions (e.g., young 
children cannot be). As a victim of disease, my body is my identity. As a
vector of disease, my microbiome is my identity. The microbiome has an impact
on the health of the human organism, but its effects are determined, in part,
by the combined 
characteristics of the microbes that comprise it. A particular species of
microbe might have positive effects in one human and negative effects in
another. These differences will complicate efforts to define what is
“normal.” Although personhood and 
identity have never been simple concepts, as we come to see ourselves as an
amalgam of us and them, we will have to rethink concepts of personal identity,
normalcy, and what they imply [4, 5]. 

Our understanding of the human microbiome and its interaction with the human
body also has implications for how we conceptualize both personhood and
personal identity. Personhood is usually defined in terms of essential and
distinguishing characteristics.
 Thus, if genes, diet, and microbes distinguish our susceptibility and
resistance to disease and responsiveness to treatments, they may all be part
of our identity [6, 7]. Furthermore, each individual’s microbiome is unique
[8]. In that sense, the 
microbiome may be incorporated into how we define ourselves as persons. 

Privacy 

For the most part, the borders of privacy conform to physical boundaries. They
coincide with personal enclosed spaces such as my body, my home, behind the
closed door of my bedroom, inside my own diary, and inside my own thoughts.
With few exceptions, no 
one may enter my private domain without my permission, and governmental
intrusions require robust justification. 

Confidentiality is different from privacy [9]. Confidentiality is an important
professional responsibility for clinicians and some other professionals (e.g.,
lawyers, accountants, priests). In these professions, an artificial space is
created within 
which information is safeguarded. Within those boundaries, information
disclosed by those seeking professional services may be shared in order to
promote the client’s interests. Outside of those boundaries, disclosed
information may be divulged only 
with the client’s permission. Thus, in medicine, patients expect their
medical history, diagnosis, and prognosis only to be shared among the health
professionals who need it for providing care. Beyond that, patients reasonably
expect their information 
not to be divulged. The assurance of confidentiality is critical for the
practice of medicine because it allows patients to freely share information. 


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