Nurs Ethics. 2014 Feb 3. [Epub ahead of print]
Informed consent, vulnerability and the risks of group-specific attribution.
Author information
- University of Vienna, Austria.
Abstract
People
in extraordinary situations are vulnerable. As research participants,
they are additionally threatened by abuse or exploitation and the
possibility of harm through research. To protect people against these
threats, informed consent as an instrument of self-determination has
been introduced. Self-determination requires autonomous persons, who
voluntarily make decisions based on their values and morals. However, in
nursing research, this requirement cannot always be met. Advanced age,
chronic illness, co-morbidity and frailty are reasons for dependencies.
These in turn lead to limited abilities or opportunities for
decision-making and self-determination. Exclusion of vulnerable people
from research projects would disadvantage them by not covering their
needs, which would violate the ethical principles of justice and
beneficence. Commonly, vulnerability is attributed to social groups. The
consequence for individuals, attributed as belonging to such a
vulnerable group, is that the principles of respect for autonomy,
justice and beneficence are subordinated to the principle of
non-maleficence, understood as avoiding the risk to cause more harm than
good. In addition, group-specific attribution could lead to
stigmatizing because labelling a person as deviation from a norm
violates integrity. For clinical nursing research, the question arises
how the protection of vulnerable people could be granted without
compromising ethical principles. The concept of relational ethics
provides a possible approach. It defines vulnerability as the relation
between a person's health status and the extent to which this person is
dependent on the researcher and the research context. Vulnerability is
not attributed solely to a person but to a situation, meaning the person
is viewed in context. By combining vulnerability as a context-related
and situational concept with existing approaches of informed consent,
the different ethical principles can be balanced and preserved at every
step of the research process.
No comments:
Post a Comment