Elsevier

Comprehensive Psychiatry

Volume 45, Issue 1, January–February 2004, Pages 1-9
Comprehensive Psychiatry

Coercion and informed consent in research involving prisoners

https://doi.org/10.1016/j.comppsych.2003.09.009Get rights and content

Abstract

Prison-based research has been limited due to concern that prisoners may represent a vulnerable population secondary to possible coercion and limited capacity for voluntary informed consent. This study was designed to assess decisional capacity and susceptibility to coercion in prison research subjects. Subjects were 30 mentally ill prisoners and 30 healthy controls. The groups were compared on ability to provide informed consent to a hypothetical drug trial, susceptibility to possible coercion, neuropsychological functioning, and psychiatric symptoms. Results indicated that all controls and all but one of the prisoners demonstrated adequate capacity to consent to the hypothetical drug trial. However, when decisional capacity was measured quantitatively, prisoners performed significantly worse regarding two aspects of this ability. Regarding possible coercion, prisoners’ main reasons for participating in research included avoiding boredom, meeting someone new, appearing cooperative in hopes of being treated better, and helping society. Neuropsychological functioning was strongly positively correlated with decisional capacity and negatively correlated with susceptibility to possible coercion, whereas psychiatric symptoms were only weakly correlated with these variables. In conclusion, a very high percentage of particularly vulnerable, mentally ill prisoners demonstrated adequate capacity to consent to research. Lower scores on a quantitative measure of decisional capacity suggest that extra care should be taken during the consent process when working with these subjects. The reasons prisoners gave for participating in our research indicated that the prison setting may have influenced their decision to participate, but that they were not actually coerced into doing so. Despite serious past incidents, ethicists will need to consider the possibility that prisoners have become an overprotected population.

Section snippets

Method

This project was approved by the University of Iowa’s Institutional Review Board (IRB). All subjects provided written informed consent to participate, following a thorough interactive discussion of the study’s procedures, risks, and benefits, and no subjects were found to lack adequate decisional capacity during this process. All assessment procedures were administered by trained research assistants.

Neuropsychological and psychiatric symptom scores

As shown in Table 1, the prison group performed significantly more poorly on RBANS Total Scale Score than did the control group, and follow-up t tests revealed that this was also the case on all of the other neuropsychological scores, with the sole exception of the RBANS Language domain. As shown in Table 2, the prison group yielded a significantly higher SCL-90-R Global Severity Index score than did the control group, and this was also the case with all nine subdomains of the SCL-90-R.

Discussion

The above data indicate that, although 29 of 30 individuals in the prison group and all 30 individuals in the control group demonstrated adequate capacity to provide consent to the hypothetical drug trial as measured by the ESC, those in the prison group earned significantly inferior MacCAT-CR scores regarding ability to understand consent form information and appreciate the potential effects of participating versus not participating. Second, neuropsychological functioning was consistently and

Acknowledgements

The authors thank John Monahan, Ph.D. of the University of Virginia and the MacArthur Foundation Research Network and staff members at the Iowa Medical and Classification Center for assistance with this study.

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  • Restraint prevalence and perceived coercion among psychiatric inpatients from South India: A prospective study

    2018, Asian Journal of Psychiatry
    Citation Excerpt :

    Subjective coercion as measured through the coercion ladder, a structured interview developed for Indian healthcare settings (Gowda et al., 2017), or the Coercion Experience Scale (CES) (Bergk et al., 2010). Perceived coercion measured through MacArthur perceived coercion scale (MAES) (Gardner et al., 1993) or the Iowa Coercion Questionnaire (ICQ) (Moser et al., 2004). Many studies evaluated coercion by assessing a single measure, concluding that it is influenced by socio-demographic and clinical variables, for example, age, gender, absent insight, severity of illness, and global functioning (Rain et al., 2003; Bindman et al., 2005; Cusack et al., 2010; Steinert et al., 2010; Sheehan and Burns, 2011; Fiorillo et al., 2012; Anestis et al., 2013; O’ Donoghue et al., 2014).

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Supported by a Clinical Research Award granted to D.J.M. by the University of Iowa College of Medicine.

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