Ethics in Psychiatry pp 421-435 | Cite as
Ethics of Research with Decisionally Impaired Patients
Abstract
The justification of non-therapeutic research on incapacitated persons is an ethical problem, because in this situation, both legitimising factors of research – informed consent and therapeutic benefit – are absent and the question arises as to whether such research is morally justifiable at all. The paper will ask if there could be arguments for such research. One argument could be that under certain circumstances, an institutionally decreed global renunciation of any type of research on this group of persons could also be illegitimate. Not doing research can do injury to the principle of Justice because in this manner the needs of a particular group may unjustifiably be ignored. This would aggravate the disadvantaged position of this group in a groundless manner and, in particular, would deprive its members of the basis of self-respect. According to the theory of justice of John Rawls each person has an equal right to the most extensive basic liberty compatible with the same liberty for others. These ‘primary goods’ are determined by the freedom and integrity of the person. Precisely this integrity of decisionally impaired persons would be endangered if one would abstain from research and thus relinquish the increase in knowledge related to their disease. Thus one could conclude, at least from Rawls’ first principle that society must take on a duty to guarantee the degrees of freedom for cognitively impaired persons and thus also support the efforts for their healing (Maio 2003).
Keywords
Minimal Risk Test Subject Human Dignity Test Person Impaired PatientReferences
- Ashcroft R (1998) Selection of human research sujects. In: Chadwick R (ed) Encyclopedia of applied ethics, vol 2. Academic Press, San Diego, CA, p 627–639Google Scholar
- Balzer P, Rippe KP, Schaber P (1998) Menschenwürde versus Würde der Kreatur. Karl Alber, Freiburg/MünchenGoogle Scholar
- Birnbacher D (1987) Gefährdet die moderne Reproduktionsmedizin die menschliche Würde? In: Braun V, Mieth D, Steigleder K (eds) Ethische und rechtliche Fragen der Gentechnologie und der Reproduktionsmedizin. Schweitzer, München, pp 77–88Google Scholar
- Caplan AL (1984) Is there a duty to serve as a subject in biomedical research? IRB: Rev Human Sub Res 6:1–5Google Scholar
- Engelhardt TH (1979) Basic ethical principles in the conduct of biomedical and behavioral research involving human subjects. Tex Rep Biol Med 38:139–168Google Scholar
- Frank S, Agich GJ (1985) Nontherapeutic research on subjects unable to grant consent. Clin Res 33:459–464Google Scholar
- Glass KC, Speyer-Ofenberg M (1992) Incompetent persons as research subjects and the ethics of minimal risk. Camb Q Healthc Ethics 5:362–372CrossRefGoogle Scholar
- Helmchen H (2008) Ethische Erwägungen in der klinischen Forschung mit psychisch Kranken. Nervenarzt 79(7):1036–1050CrossRefGoogle Scholar
- Honnefelder L (1998) Zur ethischen Beurteilung von Forschung am Menschen unter besonderer Berücksichtigung der Forschung an einwilligungsunfähigen Personen. In: Markus P (ed) Möglichkeiten, Risiken und Grenzen der Technik auf dem Weg in die Zukunft. Friedrich-Ebert-Stiftung, Bonn, pp 131–140Google Scholar
- Jonas H (1969) Philosophical reflections on experiments with human subjects. Daedalus 98:219–247Google Scholar
- Kopelman LM (1989) When is the risk minimal enough for children to be research subjects? In: Kopelman LM, Moskop JC (eds) Children and health care. Moral and social issues. Kluwer, Dordrecht, pp 89–99CrossRefGoogle Scholar
- Kress H (1999) Menschenwürde im modernen Pluralismus: Wertedebatte – Ethik der Medizin – Nachhaltigkeit. Lutheranisches Verlagshaus, HannoverGoogle Scholar
- Levine RL (1986) Ethics and regulation of clinical research. Urban Schwarzenberg, Baltimore/MünchenGoogle Scholar
- Maio G (1994) Forschung am Menschen. Eine französische Debatte. Ethik in der Medizin 6(3):143–156Google Scholar
- Maio G (2002a) Die Forschung am Menschen als ethisches Problem. Philosophische Analyse und historischer Kontext. (Medizin und Philosophie, Bd. 6) Frommann-Holzboog, StuttgartGoogle Scholar
- Maio G (2002b) The cultural specificity of research ethics – or why ethical debate in France is different. J Med Ethics 28:147–150CrossRefGoogle Scholar
- Maio G (2002c) The relevance of the principle of justice for research on cognitively impaired patients. Theor Med Bioeth – Philos Med Res Pract 23:45–53CrossRefGoogle Scholar
- Maio G (2003) Research ethics and the principle of justice as fairness – a restatement. Theor Med Bioeth – Philos Med Res Pract 24:395–406CrossRefGoogle Scholar
- McCormick RA (1974) Proxy consent in the experimentation situation. Perspect Biol Med 18:2–20Google Scholar
- National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (ed) (1978) The belmont report. Ethical principles and guidelines for the protection of human subjects in research. DHEW Publications No. (OS) 78-0012, Washington, DCGoogle Scholar
- National Council on Bioethics in Human Research (NCBHR) (ed) (1992) Report on research involving children. Prepared by the consent panel task force of the national council of bioethics in human research (NCBHR) with the support of the Canadian paediatric society. NCBHR, OttawaGoogle Scholar
- Ratzan RM (1980) Being old makes you different: the ethics of research with elderly subjects. Hastings Cent Rep 10:32–46Google Scholar
- Rawls J (1971) A theory of justice. Harvard University Press, CambridgeGoogle Scholar
- Rawls J (1982) Social unity and primary goods. In: Sen A, Williams B (eds) Utilitarism and beyond. Cambridge, Cambridge University Press, pp 159–185CrossRefGoogle Scholar
- Rawls J (1992) Der Vorrang der Grundfreiheiten. In: Hinsch W (ed) Die Idee des politischen Liberalismus. Aufsätze 1978–1989. Suhrkamp, Frankfurt a. M., pp 159–254Google Scholar
- Rawls J (1998) Eine Theorie der Gerechtigkeit. Suhrkamp, Frankfurt a. M., 8 Auflage.Google Scholar
- Taupitz J (ed) (2002) The convention on human rights an biomedicine of the council of Europe. Springer, Berlin, Heidelberg, New York, NYGoogle Scholar
- Veatch RM (1987) The patient as partner. A theory of human-experimentation ethics. Indiana University Press, Indianapolis, INGoogle Scholar
- Zentrale Ethikkommission bei der Bundesärztekammer (1997) Stellungnahme “Zum Schutz nicht-einwilligungsfähiger Personen in der medizinischen Forschung”. Deutsches Ärzteblatt 94:B811–B812Google Scholar