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And Human RightsPharmaceutical FreedomPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric EthicsPsychiatry and EmpirePsychological Concepts and Biological PsychiatryPsychology and Consumer CulturePsychology and LawPsychotropic Drug Prescriber's Survival GuidePublic Health LawPublic Health Law and EthicsPublic PhilosophyPunishing the Mentally IllPunishmentPursuits of WisdomPutting Morality Back Into PoliticsPutting on VirtueQuality of Life and Human DifferenceRaceRadical HopeRadical VirtuesRape Is RapeRe-creating MedicineRe-Engineering Philosophy for Limited BeingsReason's GriefReasonably ViciousReckoning With HomelessnessReconceiving Medical EthicsRecovery from SchizophreniaRedefining RapeRedesigning HumansReducing the Stigma of Mental IllnessReflections On How We LiveReframing Disease ContextuallyRefusing CareRefuting Peter Singer's Ethical TheoryRelative JusticeRelativism and Human RightsReligion ExplainedReprogeneticsRescuing JeffreyResponsibilityResponsibility and PsychopathyResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsResponsible GeneticsRethinking CommodificationRethinking Informed Consent in BioethicsRethinking Mental Health and DisorderRethinking RapeReturn to ReasonRevolution in PsychologyRightsRights, Democracy, and Fulfillment in the Era of Identity PoliticsRisk and Luck in Medical EthicsRobert NozickRousseau and the Dilemmas of Modernity Rule of Law, Misrule of MenRun, Spot, RunRunning on RitalinSatisficing and MaximizingSchizophrenia, Culture, and SubjectivityScience and EthicsScience in the Private InterestScience, Policy, and the Value-Free IdealScience, Seeds and CyborgsScratching the Surface of BioethicsSecular Philosophy and the Religious TemperamentSeeing the LightSelf-ConstitutionSelf-Made MadnessSelf-Trust and Reproductive AutonomySentimental RulesSex Fiends, Perverts, and PedophilesSex OffendersSex, Family, and the Culture WarsSexual DevianceSexual EthicsSexual PredatorsSexualized BrainsShaping Our SelvesShock TherapyShould I Medicate My Child?ShunnedSick to Death and Not Going to Take It AnymoreSickoSide EffectsSidewalk StoriesSister CitizenSkeptical FeminismSocial Inclusion of People with Mental IllnessSocial JusticeSociological Perspectives on the New GeneticsSome We Love, Some We Hate, Some We EatSovereign VirtueSpeech MattersSpiral of EntrapmentSplit DecisionsSticks and StonesStories MatterSubjectivity and Being SomebodySuffering, Death, and IdentitySuicide ProhibitionSurgery JunkiesSurgically Shaping ChildrenTaking Morality SeriouslyTaming the Troublesome ChildTechnology and the Good Life?TestimonyText and Materials on International Human RightsThe Aims of Higher EducationThe Almost MoonThe Altruistic BrainThe American Psychiatric Publishing Textbook of Forensic PsychiatryThe Animal ManifestoThe Animals' AgendaThe Art of LivingThe Autonomy of MoralityThe Beloved SelfThe Best Things in LifeThe Big FixThe Bioethics ReaderThe Biology and Psychology of Moral AgencyThe Blackwell Guide to Medical EthicsThe Body SilentThe BondThe Book of LifeThe Burden of SympathyThe Cambridge Companion to Virtue EthicsThe Cambridge Companion to Virtue EthicsThe Cambridge Textbook of BioethicsThe Case against Assisted SuicideThe Case Against PerfectionThe Case Against PunishmentThe Case for 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SexismThe Second-Person StandpointThe Silent World of Doctor and PatientThe Sleep of ReasonThe Social Psychology of Good and EvilThe Social Psychology of MoralityThe Social Psychology of MoralityThe Speed of DarkThe Stem Cell ControversyThe Stem Cell ControversyThe Story of Cruel and UnusualThe Story WithinThe Stubborn System of Moral ResponsibilityThe Suicide TouristThe Terrible GiftThe Theory of OptionsThe Therapy of DesireThe Trauma of Psychological TortureThe Trauma of Psychological TortureThe Triple HelixThe Trolley Problem MysteriesThe Trouble with DiversityThe Truth About the Drug CompaniesThe Ugly LawsThe Varieties of Religious ExperienceThe Virtue of Defiance and Psychiatric EngagementThe Virtues of FreedomThe Virtues of HappinessThe Virtuous Life in Greek EthicsThe Virtuous PsychiatristThe Voice of Breast Cancer in Medicine and BioethicsThe War Against BoysThe War for Children's MindsThe Whole ChildThe Woman RacketThe Worldwide Practice of TortureTherapy with ChildrenThieves of VirtueThree Generations, No ImbecilesTimes of Triumph, Times of DoubtTolerance Among The VirtuesTolerance and the Ethical LifeTolerationToxic PsychiatryTrauma, Truth and ReconciliationTreatment Kind and FairTrusting on the EdgeTry to RememberUltimate JudgementUnborn in the USA: Inside the War on AbortionUndermining ScienceUnderstanding AbortionUnderstanding CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Kant's EthicsUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and Mental DisorderVirtue EthicsVirtue, Rules, and JusticeVirtue, Vice, and PersonalityVirtues and Their VicesVulnerability, Autonomy, and Applied EthicsWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat Genes Can't DoWhat Have We DoneWhat Is a Human?What Is Good and WhyWhat Is Good and WhyWhat Is the Good Life?What Price Better Health?What Should I Do?What We Owe to Each OtherWhat Would Aristotle Do?What's Good on TVWhat's Normal?What's Wrong with Children's RightsWhat's Wrong with Homosexuality?What's Wrong With Morality?When Is Discrimination Wrong?Who Holds the Moral High Ground?Who Owns YouWho Qualifies for Rights?Whose America?Whose View of Life?Why Animals MatterWhy Animals MatterWhy I Burned My Book and Other Essays on DisabilityWhy Not Kill Them All?Why Punish? How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
This is a slim volume covering a
very specific area of research ethics: that of research in forensic mental
health settings. The book is the product of a series of seminars conducted by a
group of forensic researchers. In a selection of brief chapters by different
authors it covers a range of issues and problems, with the individual chapters
teasing out the issues in different situations. While there is no attempt to
draw the different themes into a single framework, common issues emerge through
the book. To some extent there is repetition; informed consent and competence
are themes throughout the book, and there is rather a lot of restatement of
definitions. The advantage of presenting the work as an edited collection is
that each chapter can be read in its own right, and on its own merits. Overall
I found the book interesting but uneven.
The first chapter covers the issue
of consent and competence. Gwen Adshead outlines the important distinction
between consent to treatment and consent to participation in research. Coercion
in research is always potentially problematic both ethically and
methodologically, and this issue is accentuated in the case of patients subject
to detention in treatment facilities, especially forensic settings which may
already exert a considerable coercive influence. Adshead presents views on
these issues without an undue reliance on the assumed beneficent intent of
researchers. She points out that much of the literature on research ethics is
generated by researchers, and so requires a critical reading.
Chapter two explores consent with adolescents
in forensic settings, and begins with an outline of the notion of Gillick
competence, a concept that has evolved from a House of Lords decision that age
alone is an insufficient criterion for competence. Gillick competence is
particularly important in forensic settings because of the multiple constraints
on competence: maturity, the legal definition of 'adult', education, literacy,
language, developmental delay, handicap and mental disorder. A case study
provides the focus for this chapter and while the authors acknowledge that not
all the concerns of adolescents or researchers are addressed, their case study
does provide a nice illustration of the complexities of gaining consent in
these circumstances. Statutory guardians and organizations as wells as parents
may have interests other than those of the adolescent when it comes to giving
substituted consent. The authors also describe the difficulties of compliance
with requirements for written informed consent, when the documentation becomes
so complex that it may be difficult for the proposed participant to understand.
'Dangerous stories' (Chapter Three)
outlines the limits to ownership of an individual narrative, an issue that is
likely to be especially problematic when the reasons for a person's detention
in a forensic setting involve actual harm to third parties. Under such
circumstances publication of details of the individual's life involves the
possibility of further harm to the third party, and thus challenges the
often-cited notion that individuals 'own' their life stories. As author
Christine Brown states, individual narratives are also relational, something
that needs to be considered when publication is an aim of the researcher. I was
less comfortable with Brown's assertion that such issues are beyond the scope
of 'traditional biomedical ethics', although if that term is given a narrow
interpretation that is probably true. But in identifying new ethical concerns
for researchers, it is to those traditions that ethicists return, with new interpretations
of 'autonomy' and 'beneficence'.
The chapter on qualitative research
covers the usual issues such as consent, confidentiality, and anonymity and
includes a recommendation for consumer involvement, a useful recommendation in
forensic research generally. Risk assessment is given its own chapter,
deservedly so in a discipline that owes its existence to the notion of risk.
There is unfortunately little in this chapter that relates to research,
although a lot about risk assessment. The emphasis on practice seemed out of
place given the title of the book. Multidisciplinary research is more glossed
than explored in Chapter Six. The chapter revisits ethical principles, but
without much discussion on how they might be seen by different professions. Instead
there is talk of an emerging profession of 'forensic practice', whatever that
might be. The discussion of the impact of professional rivalries on research
was more promising, but too brief.
The concluding chapters examine
Ethics Committees, and while there is a specifically local flavor to this
discussion, the chapters canvas problems with approval processes that are
common to most settings. The outline of the committee process is followed up
with a case study that exemplifies the difficulties faced by researchers in
gaining ethics approval, especially when the proposed study explores a
sensitive area such as sexuality. As Jean Ruane observes, sometimes the
concerns for rigor and ethical propriety trump the potential benefits of
research on grounds that seem hard to justify. The effect on researchers of the
demands of over zealous guardians is seldom a consideration for
Overall, this book will be useful
additional reading for those studying or considering research in forensic
mental health. Forensic mental health care, already an area with unique ethical
challenges, is likely to develop further in response to public and official
anxiety about risk. Research offers a tool to provide evidence for more
informed clinical practice and service delivery, as this book demonstrates,
such research brings its own unique ethical concerns. Doctors in particular,
especially if they have been steeped in the traditions of biological research,
will find that the varied approach opens up the task of research to new ideas
and insights. Other disciplines will find those ideas refreshed by the range of
applications to different forensic settings.
© 2005 Tony
O'Brien, M Phil., Lecturer, Mental Health Nursing, University of Auckland
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