Tuesday, May 30, 2017

Why research on involuntarily committed psychiatric patients is like research on prisoners

After the scandals uncovered by Jessica Mitford in her muckraking Atlantic Monthly article, "Experiments Behind Bars," federal guidelines placed severe restrictions on medical research with prisoners. Rightly so, too. The possibilities for exploitation are just too great. But as the cases of Dan Markingson and Robert Huber showed in Minnesota, involuntarily confined psychiatric patients can be easily exploited for similar reasons. In the latest issue of The University of Richmond Law Review, Matt Lamkin and I argue that federal guidelines should extend the protections currently given to prisoners to patients who have been involuntarily committed.

Here is an excerpt from the introduction:

Federal regulations and the research ethics literature have overlooked a captive population that requires special protections: involuntarily committed psychiatric patients. The regulations that govern much federally funded research, commonly called “the Common Rule,” exclude these patients by defining “prisoners” as encompassing only persons confined through the criminal justice system. Yet these patients are similarly susceptible to unethical research practices. Like prisoners, involuntarily committed patients are confined against their will, rendering them isolated and dependent on institutional authorities. Moreover, the length of their confinement is largely determined by authorities who at least authorize, if not conduct, any research patients may be asked to join. 

Properly applied, the general ethical principles governing human subjects research should bar the recruitment of involuntarily committed patients for most research. As with prisoners, these patients' conditions of confinement present an overwhelming barrier to voluntary consent, and their recruitment will rarely be consistent with the interests of justice. However, the lack of express protections for this population in federal regulations governing human subjects research -- together with the significant gaps in the applicability of those regulations -- leaves these patients at risk.

You can read the full article here or here.

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