Questionable Requirement for Consent in Observational Research in Psychiatry

Abstract

Informed consent represents a cornerstone of the endeavours to make health care research ethically acceptable. Based on experience of qualitative research on power dynamics in nursing care in acute psychiatry, we show that the requirement for informed consent may be practised in formalistic ways that legitimize the researcher's activities without taking the patient's changing perception of the situation sufficiently into account. The presentation of three patient case studies illustrates a diversity of issues that the researcher must consider in each situation. We argue for the necessity of researchers to base their judgement on a complex set of competencies. Consciousness of research ethics must be combined with knowledge of the challenges involved in research methodology in qualitative research and familiarity with the therapeutic arena in which the research is being conducted. The article shows that the alternative solution is not simple but must emphasize the researcher's ability to doubt and be based on an awareness of the researcher's fallibility.

‘It's unbelievably humiliating’—Patients' expressions of negative effects of coercion in mental health care

“…Persons with experiences of coercion can be considered vulnerable persons. Qualitative researchers have argued that a thoughtful consideration of the situation, rather than considering a pre-existing trait or status of the person, can be a preferred or at least additional guard against harm under some circumstances (Hem, Heggen, & Ruyter, 2007;Oeye, Bjelland, & Skorpen, 2007;Øye, Sørensen, & Glasdam, 2016). In the seminars, several of the mentioned common problems in research on coercion were absent: There was no pressure to participate from staff responsible for treatment, and it was socially acceptable to decline to discuss, not to attend, or to leave.…”

Protecting vulnerable research participants: A Foucault-inspired analysis of ethics committees

“…Nevertheless, there is a concern among researchers that an overly one-sided emphasis on consent will complicate research endeavours that use certain methods or are undertaken among certain groups of participants. 10,11,14,17 This is likely to make research on both powerful and marginalized groups more difficult, if not impossible, to carry out. Secondly, and perhaps even more commonly, there will be a general effect of discouraging those kinds of work for which researchers believe it will be difficult to get agreement from ethics committees, including (in addition to the examples already cited) research employing innovative methods or dealing with 'difficult' topics, groups or settings (p.219).…”

"I Want to Go Home, but I Need to Stay": The Transition to become Ready for Discharge from Acute Psychiatric Wards, as Narrated by Persons Who Experienced Acute Psychotic Illness

“…Interviews with a person in acute inpatient mental health care raise ethical challenges and special concerns regarding the person's vulnerability and ability to provide informed consent [33,34]. We ensured that the persons who were approached about participation obtained adequate information about the research study and had the opportunity to ask questions to better understand the information and the impact of participation(cf.…”