An Empirical Ethics Agenda for Psychiatric Research Involving Prisoners

Abstract

In the past 30 years, the incarcerated population in the United States has more than quadrupled to 2.3 million adults. With an alarmingly high prevalence of mental illness, substance use, and other serious health conditions compounding their curtailed autonomy, prisoners constitute perhaps the nation’s most disadvantaged group. Scientifically rigorous research involving prisoners holds the potential to inform and enlighten correctional policy and to improve their treatment. At the same time, prisoner research presents significant ethical challenges to investigators and institutional review boards (IRBs) alike, by subjecting participants to conditions that potentially undermine the validity of their informed consent. In 2006, the Institute of Medicine Committee on Ethical Considerations for Revisions to the Department of Health and Human Services (DHHS) Regulations for Protection of Prisoners Involved in Research recommended both further protections and a more permissive approach to research review that would allow inmates greater access to potentially beneficial research. These recommendations have sparked renewed debate about the ethical trade-offs inherent to prisoner research. In this article, the authors review the major justifications for research with prisoner subjects and the associated ethical concerns, and argue that the field of empirical ethics has much to offer to the debate. They then propose a framework for prioritizing future empirical ethics inquiry on this understudied topic.

Ethical and Social Issues in Health Research Involving Incarcerated People

“…Christopher et al 16 provided an agenda that should be undertaken for empirical studies to understand ethical issues in mental health research involving inmates, including studies of the decisional capacity of incarcerated research participants who may be mentally ill or suffering from medical illnesses that affect decision making; possible coercive influences (e.g., financial compensation or favorable treatment from prison authorities in return for taking part in a study); therapeutic misconception (i.e., viewing research as treatment despite the important difference between medical care and clinical research); and IRB oversight.…”

Mental Health Research in Correctional Settings: Perceptions of Risk and Vulnerabilities

“…Individuals in correctional environments are vulnerable not only due to healthcare disparities but also because of restrictions on autonomy, privacy, and liberty inherent in these settings. Contextual issues unique to corrections (e.g., stress of incarceration, trauma, desperation, lack of privacy) are all factors that can affect the decisional capacity of research participants (Christopher, Candilis, Rich, & Lidz, 2011). In a recent study examining perceived coercion among 84 offenders, 51% of participants agreed with the statements “I felt the judge would like it if I entered the study” and “I felt that entering the study would help my court case” (Dugosh, Festinger, Croft, & Marlowe, 2010).…”

An exploratory study of therapeutic misconception among incarcerated clinical trial participants

“…Among the potential reasons for participating in a clinical trial, those who are incarcerated may choose to enroll out of a desire to access treatment that they believe will be better than what they are already receiving or than what is otherwise available. Under such circumstances, it seems plausible that incarcerated persons may be susceptible to viewing such research as primarily intended to help them (as participants) and to overestimating the likelihood and extent to which they will benefit from participating in the research study (Christopher et al 2011). These are core features of a phenomenon known as therapeutic misconception (Appelbaum et al 1982).…”