Disagreement About Consent
A scenario meant to stimulate discussion about the ethical issues that arise when members of the health care team disagree about whether a mentally ill patient has actually given informed consent.
You are a research fellow in the Department of Psychiatry. A nurse on the inpatient schizophrenia research unit complains to you that two patients who agreed to participate in a challenge study are now quite symptomatic. The nurse is concerned that the patients were "too impaired" when they gave consent to participate. Dr. B, the Director of the unit and principle investigator of the study points out that one of the patients, Ms. Jones, had signed an advance directive six months previously (when she was relatively unimpaired) giving Dr. B authority to enroll her in "a study that might temporarily worsen her symptoms." You are concerned because Ms. Jones has become very symptomatic and seems to be suffering "more than necessary."
- What are the strengths and weaknesses of advance directives in cases like this?
- How would you work an advance directive?
- When should advance directives be ignored or overruled?
Caroline Whitbeck introduced methods and modules for discussing numerous issues in responsible conduct of research at a Sigma Xi Forum in 2000. Partial funding for the development of this material came from an NIH grant.
You can find the entire sequence on the OEC at Scenarios for Ethics Modules in the Responsible Conduct of Research. Some information in these historical modules may be out-of-date; for instance, there may be a new edition of the professional society's code that is referred to in an item. If you have suggestions for updates, please contact the OEC.