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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