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HHS/FDA RIN: 0910-AC25 Publication ID: Spring 2002 
Title: Exception From General Requirements for Informed Consent; Request for Comments and Information 
Abstract: FDA is proposing to clarify its regulations about the exception from the general requirement for informed consent in life-threatening situations necessitating the use of a test article. This clarification will explain how the regulations would apply during emergencies, including a response to chemical or biological terrorism, requiring the use of investigational products regulated by FDA. 
Agency: Department of Health and Human Services(HHS)  Priority: Other Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Proposed Rule Stage 
Major: No  Unfunded Mandates: No 
CFR Citation: 21 CFR 50.23 
Legal Authority: 21 USC 321; 21 USC 346; 21 USC 346a; 21 USC 348; 21 USC 352; 21 USC 353; 21 USC 355; 21 USC 360; 21 USC 360bbb; 21 USC 360c; 21 USC 360d; 21 USC 360e; 21 USC 360f; 21 USC 360h; 21 USC 360i; 21 USC 360j; 21 USC 371; 21 USC 379e; 21 USC 381; 42 USC 241; 42 USC 262; 42 USC 263b-263n 
Legal Deadline:  None

Statement of Need: The agency is proposing this action because of concern that confusion exists about how to apply the informed consent rules during a potential emergency, including a chemical or biological terrorism event. This confusion could delay the immediate use of investigational products thus threatening the rights, welfare, or lives of subjects.

Summary of the Legal Basis: FDA has already determined that the statutory authority provided in the Federal Food, Drug and Cosmetic Act (the Act) allows a limited exception to requiring informed consent in life-threatening situations such as those considered here. Section 505(i) of the Act requires informed consent except where it is not feasible or it is contrary to the best interests of the human beings involved. The Act also provides specifically for an exception from informed consent for investigational devices. Section 520 (g) (3) (D) of the Act requires informed consent of the subject unless the clinical investigator determines in writing that: 1) there exists a life-threatening situation involving the human subject of such testing which necessitates the use of such device; 2) it is not feasible to obtain informed consent from the subject; and 3) there is not sufficient time to obtain such consent from his or her representative. Further, a licensed physician uninvolved in the testing must agree with this three-part determination before using the product, unless immediate use of the device is required to save the life of the human subject of such testing and there is not sufficient time to get such concurrence. The statute states that the exceptions to requiring informed consent are subject to such conditions as the Secretary may prescribe. This proposed rule is not required by statute or court order.

Alternatives: The only other option open to the agency is to do nothing. FDA believes that this option is not acceptable because it could result in improper treatment or no treatment for persons with serious illnesses because the health professionals could not use these investigational products in absence of informed consent.

Anticipated Costs and Benefits: The minimal burdens imposed by this rule are offset by the fact that, in the absence of this rule, the sponsor would be required to obtain informed consent, which is just as burdensome, if not more so. The rule would permit use of investigational products without which patients' lives might be threatened. Because of uncertainty about the nature or extent of any chemical or biological terrorism event, FDA cannot estimate the extent of the benefits of this rule.

Risks: The primary risk addressed by this rule is the risk that patients may go untreated or may be improperly treated because health professionals could not use an investigational product in the absence of informed consent. FDA cannot determine the extent of this risk without knowing the nature or extent of any chemical or biological terrorism event.

Timetable:
Action Date FR Cite
NPRM  06/00/2002   
Regulatory Flexibility Analysis Required: No  Government Levels Affected: None 
Small Entities Affected: No  Federalism: No 
Included in the Regulatory Plan: Yes 
Agency Contact:
Bonnie M. Lee
Associate Director for Human Subject Protection Policy
Department of Health and Human Services
Food and Drug Administration
Room 9C24 (HF-34), Office of Good Clinical Practice, Office of Science Coordination & Communication, 5600 Fishers Lane,
Rockville, MD 20857
Phone:301 827-1259
Fax:301 827-1169
Email: blee@oc.fda.gov

 
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