Questionable Requirement for Consent in Observational Research in Psychiatry

Section for Health Science, Faculty of Medicine, University of Oslo, PO Box 1153 Blindern, NO-0318 Oslo, Norway.
Nursing Ethics (Impact Factor: 1.25). 02/2007; 14(1):41-53. DOI: 10.1177/0969733007071357
Source: PubMed


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.

Download full-text


Available from: Marit Helene Hem,
  • Source
    • "This shows that there is much to gain when making observations in such a context, but that the disadvantages for individuals must not be overlooked. Hem et al. (2007) argue that the principle of obtaining informed consent is extremely problematic when making observations in acute psychiatric care, especially in the case of patients with a psychosis; it requires both ethical awareness, knowledge of challenges in the qualitative research methodology and specialist therapeutic competence from the researcher (Hem et al. 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: You find Abstract at
    04/2009, Degree: PhD, Supervisor: Professor Ella Danielson, Professor Ingela Skärsäter
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The equitable provision of care is a core principle of the NHS. Previous research suggests that older cancer patients may be less likely to use specialist palliative care than younger patients, but studies have failed to fully define and measure clinical need. The aim of this study was to examine use of specialist palliative care in relation to age, after controlling for need. I used a mixed methods approach, grounded in a pragmatic philosophy and drawing upon a health capability account of equitable healthcare. I undertook a focused ethnography of three specialist palliative care services, using documentary evidence, observation of meetings, and interviews to investigate conceptualisations of need for care. I derived two models of need. The first ‘aspirational’ model encompassed physical, psychological, social and spiritual care for patients and carers. However, with limited resources, a predominantly physical model of need was applied. Additionally, observations suggested that care may vary in relation to patient characteristics including age. To locate a suitable measure of need, I conducted a systematic literature review and critical and content appraisal of health-related quality of life instruments. I chose the EORTC QLQ-C30 instrument as the indicator of need in a cross-sectional survey of patients and carers, conducted to measure use of specialist palliative care in relation to age. 252 patients and 137 carers attending four outpatient lung cancer clinics participated. 39% received specialist palliative care. Age was not associated with use of specialist palliative care; metastatic disease, global quality of life (‘need’) and the clinic where treatment was provided were. These findings suggest equitable use of specialist palliative care. However, a comprehensive account of equity must consider both use and quality of care. There were some suggestions that, within a resource-limited context, the quality of care may vary. Future equity research should prospectively consider variations in use and quality of specialist palliative care for different patient groups across all care settings, and from diagnosis to death.
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article reviews ethical issues and dilemmas that arise from the dual roles of the social work researcher: as scientist and as someone who cares for individuals and groups in distress while exercising social control. There is a fair amount of tension between the roles of social worker and social work researcher due to a lack of clear boundaries of the researchers function. The ethical dilemmas may vary with the framework in which the research is conducted, the participants, and social work researchers themselves. The current article focuses on issues of informed consent, expectations, and anxieties of the research participants, and ethical dilemmas. It ends with suggestions for ethical social work research.
    Families in society: the journal of contemporary human services 10/2008; 89(4):571-577. DOI:10.1606/1044-3894.3826 · 0.29 Impact Factor
Show more