Dr. Ethan Cowan is an Assistant Professor in the Department of Emergency Medicine at the Albert Einstein College of Medicine. With a background in research on informed consent for clinical procedures, Dr. Cowan is now seeking to develop expertise in empirical research in bioethics. Dr. Cowan is planning to study the intersection of bioethics as it applies to the individual and the health of the public. Emergency Departments (EDs) are a unique environment for this type of research because they provide individual clinical care and serve as a """"""""safety net"""""""" for the population by treating the uninsured and underserved making it difficult to separate clinical and public health practice. The proposed study examines the ethical implications of a new public health initiative, opt-out provider-initiated HIV testing (hereby referred to as opt-out testing) in the ED. A mixture of qualitative and quantitative methods will be used to explore ED patients'and providers'beliefs, attitudes and acceptability toward opt-out testing. Ethical aspects of opt-out HIV testing will be examined including, 1) the ability of patients to understand that they have the right to decline the HIV test and that testing will be performed unless they exercise that right, 2) patients'understanding of HIV pretest information prior to undergoing testing, and 3) the impact of language on the understanding of opt-out testing and HIV pretest information. The research will be conducted in the urban ED of the Jacobi Medical Center, serving over 70,000 adult patients annually and staffed by faculty experienced in conducting NIH clinical trials. Dr. Cowan's training plan includes formal coursework, direct mentoring, specialized seminars, and practical experience in project planning and execution. Courses have been selected from the sociomedical sciences curriculum of Columbia University and the ethics program at Union Graduate College. Headed by a world renowned ethicist, Dr. Ruth Macklin, a committee of experts in clinical research methods will serve as mentors for this project. The proposed research has direct impact on public health. The instruments developed in this study may be adapted for use in evaluating and monitoring the ethical aspects of national and international opt-out testing programs. Furthermore, if this study demonstrates that opt-out testing is acceptable and can be ethically implemented this will lend support for adoption of ED based opt-out testing programs on a national scale.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Mentored Patient-Oriented Research Career Development Award (K23)
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Acquired Immunodeficiency Syndrome Research Review Committee (AIDS)
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Roe, Joanad'Arc C
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Albert Einstein College of Medicine
Emergency Medicine
Schools of Medicine
United States
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Cowan, Ethan; Klerman, Hadassa; Ma, Jeffrey (2015) Capacity to Consent to Research in Patients with Acute Pain: A Pilot Study. IRB 37:1-6
Cowan, Ethan A; Macklin, Ruth (2014) Is preexposure prophylaxis ready for prime time use in HIV prevention research? AIDS 28:293-5
Cowan, Ethan; Leider, Jason; Velastegui, Lorena et al. (2013) A qualitative assessment of emergency department patients' knowledge, beliefs, attitudes, and acceptance toward revised HIV testing strategies. Acad Emerg Med 20:287-94
Macklin, Ruth; Cowan, Ethan (2012) Given financial constraints, it would be unethical to divert antiretroviral drugs from treatment to prevention. Health Aff (Millwood) 31:1537-44
Cowan, Ethan; Macklin, Ruth (2012) Unconsented HIV testing in cases of occupational exposure: ethics, law, and policy. Acad Emerg Med 19:1181-7
Yadav, Kabir; Cowan, Ethan; Wall, Stephen et al. (2011) Orbital fracture clinical decision rule development: burden of disease and use of a mandatory electronic survey instrument. Acad Emerg Med 18:313-6
Musiime, Stephenson; Muhairwe, Fred; Rutagengwa, Alfred et al. (2011) Adherence to highly active antiretroviral treatment in HIV-infected Rwandan women. PLoS One 6:e27832
Li, Siu Fai; Latib, Nashat; Kwong, Angela et al. (2007) Gender trends in emergency medicine publications. Acad Emerg Med 14:1194-6