Beyond informed consent: the therapeutic misconception and trust

Abstract

The therapeutic misconception has been seen as presenting an ethical problem because failure to distinguish the aims of research participation from those receiving ordinary treatment may seriously undermine the informed consent of research subjects. Hence, most theoretical and empirical work on the problems of the therapeutic misconception has been directed to evaluate whether, and to what degree, this confusion invalidates the consent of subjects. We argue here that this focus on the understanding component of informed consent, while important, might be too narrow to capture the ethical complexity of the therapeutic misconception. We show that concerns about misplaced trust and exploitation of such trust are also relevant, and ought to be taken into account, when considering why the therapeutic misconception matters ethically.

Children in health research: a matter of trust

“…Trust was not based on a two-person relationship, but on a number of interrelated relationships. Indeed, the findings of this study support the assertion of de Melo-Martin and Ho36 that ‘relations of trust’ extend beyond individual researchers to committees and institutions like research ethics boards and hospitals. This has received only limited attention in the literature and more work is required to better understand the complex ‘network of trust’ in child health research and its implications for risk assessment when making decisions about participation in research studies.…”

Why do participants enroll in population biobank studies? A systematic literature review

“…Besides acknowledging the fact that these Special Report expectations might be the expression of some personal belief or hope, Dixon-Woods et al also argue that they can originate in the amount of trust conferred to the organizing bodies [35]. This goes along the same line as a study about therapeutic misconception interpreted as a misplaced trust toward the researchers or the research institution [54]. On the other hand, Ormond et al suggest that an informed consent that mentions different recontact options may be perceived as unclear and, as such, may trigger undue expectations [42].…”

Increasing participation in critical care studies: the need to understand surrogate decision-makers for critically ill patients

“…The only factor which enhanced the rate of consent was the inclusion of a clinical update on the patient's condition at the time of approaching the SDM. This result underlines the importance of SDMs in the relationship based on the clinical situation of the patient but also the risks of therapeutic misconception [12].…”