Ethical Problems in Performing Research on Individuals With Compromised Autonomy: Children, the Elderly, and the Mentally Ill

Freeman, Jane Alison Dorothy (2001) Ethical Problems in Performing Research on Individuals With Compromised Autonomy: Children, the Elderly, and the Mentally Ill. MPhil(R) thesis, University of Glasgow.

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In this thesis, I explore the range of ethical problems that are seen in research generally, and in research involving individuals with compromised autonomy more specifically - that is, children, the elderly, and the mentally ill. Chapter 1 deals with reasons why ethical issues surrounding research are becoming more important, and the focus society has on rights, autonomy, and consent. Problems with consent (definition, amount of information to disclose, communication difficulties, and risk-benefit analysis) are explored. The ethical implications of research versus experimentation, and clinical versus non-clinical research are analysed. Problems with clinical research (such as involvement of ill people and conflict or interest) are assessed, as are the problems of non-therapeutic research (use of well people, motivation to participate, and the role of patient consent). This forms the background for an analysis of research on those who have compromised autonomy - children, the elderly, and the mentally ill. Chapter 2 relates to problems with research on children, assessing the role of parental consent and its advantages (preservation of family relationships and access to benefits of trial) and disadvantages (problems with parental understanding, and the idea that it represents necessarily the views and best interests of the child). The autonomy of the child is also assessed, and seen to be limited by balance of power, difficulties ensuring understanding and voluntary consent, and problems specific to adolescents. Psychosocial research is also analysed, as is the conflict of the doctor's involvement in paediatric research. Chapter 3 relates to research involving the elderly and why this is important. Autonomy of the elderly may be compromised by a number of factors, such as ambiguity in terminology applied to the elderly, stereotype, extrinsic factors such as poverty and family relationships, and intrinsic factors, such as cognitive impairment, deafness, blindness, and so forth. Problems obtaining consent relate to the above factors, as well as institutionalisation and the pressures from family. However, research in this group is also important as they have problems which cannot be researched in other groups. Chapter 4 assesses problems in performing research on the mentally ill, which are particularly highlighted through past exploitation of psychiatric patients. Autonomy in the mentally ill is threatened by a number of factors, such as the wide range of capabilities the mentally ill have; stigmatisation; communication, reasoning, and assessment problems; involuntary hospitalisation and treatment, and the use of psychotropic medications; and deranged interpersonal relationships. Children and the elderly who also have mental illness have extra problems and need careful handling for research. The doctor-patient relationship may also be jeopardised, which is even more significant in a group with fewer social supports. In summary, there may be seen to be a number of factors which compromise the autonomy of children, the mentally ill, and the elderly. A recognition of these factors, coupled with practical measures to optimise consent and the acceptability of research, can help make such research more ethical. It is important to perform such research, in order to maximise the happiness and well-being of these individuals.

Item Type: Thesis (MPhil(R))
Qualification Level: Masters
Additional Information: Adviser: Robin Downie
Keywords: Medical ethics
Date of Award: 2001
Depositing User: Enlighten Team
Unique ID: glathesis:2001-76051
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 19 Dec 2019 09:15
Last Modified: 19 Dec 2019 09:15

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