Ethics in Mental Health Research: Principles, Guidance, and Cases.
Article Type: Book review
Subject: Books (Book reviews)
Author: Wendler, David
Pub Date: 03/01/2010
Publication: Name: IRB: Ethics & Human Research Publisher: Hastings Center Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 Hastings Center ISSN: 0193-7758
Issue: Date: March-April, 2010 Source Volume: 32 Source Issue: 2
Topic: NamedWork: Ethics in Mental Health Research: Principles, Guidance, and Cases (Nonfiction work)
Persons: Reviewee: DuBois, James M.
Accession Number: 239352099
Full Text: James M. DuBois, Ethics in Mental Health Research: Principles, Guidance, and Cases, New York: Oxford University Press, 2007. 256 pages. $29.95 hardcover.

Those involved in research with humans confront a host of ethical issues and a maze of regulations. Research participants should be respected, the risks they face minimized, and their confidentiality and privacy protected. This should be done in a way that advances the goal of improving health and well-being through the collection of valuable and valid data; that takes into account the conflicts of interest that inevitably exist in the pursuit of this goal; and that is consistent with applicable laws, regulations, and guidelines.

While this sounds like an impossible task, James M. DuBois's Ethics in Mental Health Research: Principles, Guidance, and Cases is here to help. The book covers a broad range of issues in research ethics, including informed consent, risks and benefits, privacy and confidentiality, and conflicts of interest. Thus, while the title focuses on mental health research, the book should also be of interest to individuals involved in other types of human subjects research.

Ethics in Mental Health Research is not designed to provide an in-depth and comprehensive analysis of the included topics. Instead, think of it as a guidebook to a complex land. This is not a guidebook for those who want others to do the work for them, to be told exactly what to do and how to do it. Instead, it is a resource for those who are interested in and committed to learning how to promote ethically responsible research with humans. Individuals so dedicated--whether investigators, funders, or reviewers--will find in the author a clear, patient, and experienced guide who knows the terrain well and offers readers the resources to address the issues they encounter.

DuBois, who is more interested in practical lessons than theoretical ones, begins with a brief framework for addressing ethical issues, based on the four principles of bioethics: autonomy, beneficence, nonmaleficence, and justice. He suggests these principles can be traced to what he calls "the mother of all ethical principles for human interactions," respect for human beings (p. 31). He then argues that respect for human beings should not be reduced to respect for their autonomy. We are more than our ability to make decisions, and it is important to respect us in all our complexity.

DuBois also notes that some humans are not autonomous. Hence, the grounding principle is intentionally characterized in terms of respect for human beings, rather than respect for persons. He notes that respect for all human beings is "consistent with the Common Rule and the Belmont report," which provide increased protections for nonautonomous humans (p. 35). Moving from principles to practice, he describes the SFNO framework for addressing ethical issues: identify the affected Stakeholders, determine the relevant Facts, consider the applicable Norms and principles, and evaluate the available Options. He then offers cases for the reader to evaluate with the help of this framework, along with a range of references, Web sites, and regulations to address them. The book covers many of the important issues in the field, including whether there is a duty to participate in research, when the risks of research are acceptable, what constitutes a benefit of research participation, whether there is an obligation to compensate participants for injuries incurred during research, and whether it is acceptable to deceive research participants.

Some readers may be frustrated to find that the discussion of these important and complex issues is often brief, with many topics receiving only a paragraph. For example, DuBois considers the controversial issues of challenge and treatment withdrawal studies and placebo trials for severe mental illness. He argues that these trials should be allowed provided there is sufficient protection for participants, and no better alternatives for treatment exist. Guidance is provided, but no answers on what precisely constitutes sufficient protection. Readers looking for concrete proposals and answers will need to look elsewhere, and the book provides a wealth of resources and references to get them started. Or, perhaps more in the spirit of DuBois's approach, readers should evaluate for themselves what constitutes an acceptable approach to the presented cases.

DuBois includes research on drug abuse under mental health research. While this reflects current thinking in the field, it is worth noting that society and the law often regard drug abuse as a matter for courts and lawyers, not hospitals and doctors. As a result, drug abuse research can lead to involvement in research with prisoners. This can happen inadvertently when individuals enroll in research and subsequently become involved in the criminal justice system. Although research with prisoners finds brief mention here, readers will have to look elsewhere--perhaps until a revised edition--for sustained discussion of the ethical issues it raises.
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