email page print pageAll Topic Reviews
50 Signs of Mental IllnessA Beautiful MindA Beautiful MindA Bright Red ScreamA Casebook of Ethical Challenges in NeuropsychologyA Corner Of The UniverseA Lethal InheritanceA Mood ApartA Research Agenda for DSM-VA Slant of SunA War of NervesAbnormal Psychology in ContextADD-Friendly Ways to Organize Your LifeAddiction Recovery ToolsAdvance Directives in Mental HealthAggression and Antisocial Behavior in Children and AdolescentsAl-JununAlmost a PsychopathAlterations of ConsciousnessAm I Okay?American ManiaAmerican Psychiatric Publishing Textbook of Neuropsychiatry and Clinical NeurosciencesAn American ObsessionAngelheadAnger, Madness, and the DaimonicAnthology of a Crazy LadyApproaching NeverlandAs Nature Made HimAsylumAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderBeing Mentally Ill: A Sociological Theory Betrayal TraumaBetrayed as BoysBetter Than ProzacBetter Than WellBeyond AppearanceBeyond ReasonBinge No MoreBiological UnhappinessBipolar DisorderBipolar DisorderBipolar Disorder DemystifiedBlack-eyed SuzieBlaming the BrainBleeding to Ease the PainBluebirdBlueprints Clinical Cases in PsychiatryBody Image, Eating Disorders, and ObesityBorderline Personality DisorderBrain Circuitry and Signaling in PsychiatryBrave New BrainBreakdown of WillBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerCalm EnergyCassandra's DaughterCaught in the NetChild and Adolescent Treatment for Social Work PracticeChildren Changed by TraumaChronic Fatigue Syndrome (The Facts)Clinical Handbook of Psychological DisordersClinical Manual of Women's Mental HealthCognitive Theories of Mental IllnessCommonsense RebellionCommunity and In-Home Behavioral Health TreatmentComprehending SuicideConcise Guide to Child and Adolescent PsychiatryConquering Post-Traumatic Stress DisorderConscience and ConvenienceConsciousnessConsole and ClassifyContesting PsychiatryCoping With TraumaCopshockCrazy for YouCrazy in AmericaCrazy Like UsCreating HysteriaCritical PsychiatryCruel CompassionCultural Assessment in Clinical PsychiatryCulture and Mental HealthCulture and Psychiatric DiagnosisCultures of NeurastheniaDaddy's GirlsDante's CureDarwinian PsychiatryDaughter of the Queen of ShebaDaughters of MadnessDeinstitutionalization And People With Intellectual DisabilitiesDelivered from DistractionDepression In Later LifeDepression SourcebookDepression-Free for LifeDescriptions and PrescriptionsDestructive Trends in Mental HealthDevil in the DetailsDiagnosis: SchizophreniaDiagnostic and Statistical Manual of Mental Disorders DSM-IV-TRDirty Filthy Love DVDDisorders Of DesireDisrupted LivesDissociative ChildrenDivided MindsDr. Andrew Weil's Guide to Optimum HealthDr. Weisinger's Anger Work-Out BookDSM-IV SourcebookDSM-IV-TR CasebookDSM-IV-TR in ActionDSM-IV-TR Mental DisordersE-TherapyEccentricsElectroshockEmergencies in Mental Health PracticeEmergency PsychiatryEmotional and Behavioral Problems of Young ChildrenEmotions and LifeEmpowering People with Severe Mental IllnessEssential PsychopharmacologyEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics and Values in PsychotherapyEthics in Mental Health ResearchEthics in Psychiatric ResearchEthics, Culture, and PsychiatryEverything In Its PlaceFamily Experiences With Mental IllnessFatigue as a Window to the BrainFear of IntimacyFinding Iris ChangFinding Meaning in the Experience of DementiaFlorid StatesFolie a DeuxFor the Love of ItForensic Nursing and Multidisciplinary Care of the Mentally Disordered OffenderFountain HouseFrom Madness to Mental HealthFrom Trauma to TransformationGandhi's WayGender and Its Effects on PsychopathologyGender and Mental HealthGenes, Environment, and PsychopathologyGetting Your Life BackGracefully InsaneGrieving Mental IllnessHandbook of AttachmentHandbook of DepressionHandbook of Self and IdentityHealing the SplitHerbs for the MindHidden SelvesHigh RiskHope and DespairHow Clients Make Therapy WorkHow People ChangeHow to Become a SchizophrenicHow We Think About DementiaHughes' Outline of Modern PsychiatryHumanizing MadnessHysterical MenHystoriesI Hate You-Don't Leave MeI Never Promised You a Rose GardenI Thought I Could FlyI'm CrazyImagining RobertImpulse Control DisordersIn Others' EyesIn Two MindsInsanityIntegrated Behavioral Health CareIntegrative MedicineIntegrative Mental Health CareIntuitionJust CheckingKarl JaspersKissing DoorknobsKundalini Yoga Meditation for Complex Psychiatric DisordersLaw and the BrainLaw, Liberty, and PsychiatryLegal and Ethical Aspects of HealthcareLiberatory PsychiatryLife at the BottomLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLithium for MedeaLiving Outside Mental IllnessLiving with AnxietyLiving With SchizophreniaLiving with SchizophreniaLiving Without Depression and Manic DepressionLost in the MirrorLove's ExecutionerLoving Someone With Bipolar DisorderMad in AmericaMad TravelersMad, Bad and SadMadhouseMadnessMadness at HomeMadness in Buenos AiresManaged Care ContractingMandated Reporting of Suspected Child AbuseManic Depression and CreativityMary BarnesMasters of the MindMeasuring PsychopathologyMedia MadnessMedicine As MinistryMelancholy And the Care of the SoulMemory, Brain, and BeliefMental HealthMental Health At The CrossroadsMental Health Issues in Lesbian, Gay, Bisexual, and Transgender Communities Mental Health MattersMental Health Policy in BritainMental Health Policy in BritainMental Health Professionals, Minorities and the PoorMental IllnessMental Illness and Your TownMental Illness, Medicine and LawMental SlaveryMindfulness in Plain EnglishModels of MadnessMothers Who Kill Their ChildrenMozart's Brain and the Fighter PilotMultifamily Groups in the Treatment of Severe Psychiatric DisordersMuses, Madmen, and ProphetsMyths of ChildhoodNapkin NotesNeural MisfireNew Hope For People With Bipolar DisorderNight Falls FastNo Enemies WithinNolaNormalNot CrazyNovember of the SoulOf Two MindsOn Being Normal and Other DisordersOn Our Own, TogetherOn The Stigma Of Mental IllnessOrigins of Human NatureOut of Its MindOut of the ShadowsOvercoming Compulsive HoardingPathologies of BeliefPathways through PainPersonal Recovery and Mental IllnessPersonality Disorder: Temperament or Trauma?Pillar of SaltPoints of ViewPoppy ShakespearePosttraumatic Stress DisorderPsychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric Genetics and GenomicsPsychiatric Illness in WomenPsychiatrists and Traditional HealersPsychiatryPsychiatry and ReligionPsychiatry in SocietyPsychological Dimensions of the SelfPsychology and the MediaPsychopathia SexualisPsychopathologyPsychopathyPsychotic DepressionQuitting the Nairobi TrioRaising a Moody ChildRapid Cognitive TherapyRebuilding Shattered LivesReclaiming Soul in Health CareReclaiming the SoulRecollection, Testimony, and Lying in Early ChildhoodRecovery from SchizophreniaRecovery in Mental IllnessRedressing the EmperorRelational Mental HealthRemembering TraumaRepressed SpacesResearch Advances in Genetics and GenomicsRestricted AccessRethinking the DSMReviving OpheliaRewarding Specialties for Mental Health CliniciansSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSchizophreniaSchizophrenia RevealedSchizophrenia: A Scientific Delusion?Self-Determination Theory in the ClinicShunnedShynessSigns of SafetySilencing the VoicesSlackjawSocial Cognition and SchizophreniaSocial Inclusion of People with Mental IllnessSoul Murder RevisitedSounds from the Bell JarSpeaking Our MindsSpontaneous HealingStop PretendingStraight Talk about Psychological Testing for KidsStranger Than FictionStreet CrazyStudy Guide to the DSM-IV-TRSurviving Manic DepressionSurviving SchizophreniaSurviving SchizophreniaTaking Charge of ADHD, Revised EditionTaking the Fear Out of ChangingTalking Back to PsychiatryTarnationTeen LoveTelling Is Risky BusinessTelling SecretsThe Age of InsanityThe American Psychiatric Press Textbook of PsychiatryThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anger WorkbookThe Anorexic SelfThe Behavioral Medicine Treatment PlannerThe Betty Ford Center Book of AnswersThe Bipolar ChildThe Bipolar Disorder Survival GuideThe Body in PsychotherapyThe Borderline Personality Disorder Survival GuideThe Broken MirrorThe Burden of SympathyThe Cambridge Medical Ethics WorkbookThe Case for Pragmatic PsychologyThe Center Cannot HoldThe Chemical Dependence Treatment Documentation SourcebookThe Chemical Dependence Treatment PlannerThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Condition of MadnessThe Construction of Power and Authority in PsychiatryThe Couples Psychotherapy Treatment PlannerThe Criminal BrainThe Cultural Context of Health, Illness, and MedicineThe Day the Voices StoppedThe Death of PsychotherapyThe Depression WorkbookThe Difficult-to-Treat Psychiatric PatientThe Early Stages of SchizophreniaThe Employee Assistance Treatment PlannerThe Employee Assistance Treatment PlannerThe Epidemiology of SchizophreniaThe Essential Family Guide to Borderline Personality DisorderThe Essentials of New York Mental Health LawThe Ethical WayThe Evolution of Mental Health LawThe Explosive ChildThe Fall Of An IconThe Fasting GirlThe Forensic Documentation SourcebookThe Forgotten MournersThe Gift of Adult ADDThe Good EaterThe Green ParrotThe Healing Power of PetsThe Heart of AddictionThe Heroic ClientThe Insanity OffenseThe Invisible PlagueThe Last Time I Wore a DressThe Limits of Autobiography The LobotomistThe Madness of Our LivesThe Mark of ShameThe Meaning of AddictionThe Meaning of MindThe Medical AdvisorThe Mind/Mood Pill BookThe Most Solitary of AfflictionsThe Mozart EffectThe Naked Lady Who Stood on Her HeadThe Older Adult Psychotherapy Treatment PlannerThe OutsiderThe Pastoral Counseling Treatment PlannerThe PDR Family Guide to Natural Medicines & Healing TherapiesThe Places That Scare YouThe Plural SelfThe Problem of EvilThe Psychology of Religion and CopingThe Quiet RoomThe Real World Guide to Psychotherapy PracticeThe Right to Refuse Mental Health TreatmentThe Rise of Mental Health NursingThe Roots of the Recovery Movement in PsychiatryThe Savage GirlThe Self-Help SourcebookThe Talking CureThe Trick Is to Keep BreathingThe Unwell BrainThe Virtuous PsychiatristThe Way of TransitionThe Wing of MadnessThe Wisdom in FeelingTheoretical Evolutions in Person-Centered/Experiential TherapyTherapy's DelusionsTheraScribe 3.0 for WindowsThis is Madness TooThoughts Without a ThinkerThrough the Looking GlassTo Have Or To Be?Toxic PsychiatryTransforming MadnessTraumaTraumatic PastsTraumatic Relationships and Serious Mental DisordersTreating Affect PhobiaTreating Chronic and Severe Mental DisordersTreating Self-InjuryTreatment and Rehabilitation of Severe Mental IllnessTreatment Plans and Interventions for Depression and Anxiety DisordersTwinsUnderstanding and Treating Violent Psychiatric PatientsUnderstanding Child MolestersUnderstanding DepressionUnderstanding ParanoiaUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnholy MadnessUnspeakable Truths and Happy EndingsUsers and Abusers of PsychiatryViolence and Mental DisorderVoices of MadnessVoices of RecoveryVulnerability to PsychopathologyWarning: Psychiatry Can Be Hazardous to Your Mental HealthWashing My Life AwayWhen History Is a NightmareWhen Someone You Love Is BipolarWhen the Body SpeaksWhen Walls Become DoorwaysWitchcrazeWomen and Borderline Personality DisorderWomen and Mental IllnessWomen Who Hurt ThemselvesWomen's Mental HealthWrestling with the AngelYou Must Be DreamingYour Drug May Be Your ProblemYour Miracle Brain
In this comprehensive book James DuBois explores ethical principles and guidelines that are essential for any researcher or Institutional Review Board member to work ethically within the practice of human mental health research. While the book focuses on the ethics of research conducted with humans who have mental health disorders and provides a framework for ethical research with such humans, the ethics framework provided is applicable to research conducted with all human beings (not just those humans who have mental health disorders).
This is a well-constructed book with the first three chapters concentrating on laying the theoretical foundations for the ethics framework. Significance is placed on four principles: autonomy, beneficence, nonmaleficence and justice (p. 30). DuBois aims to 'humanize' these principles, that is, he intends to 'explain how all ethical principles are expressions of respect for humanity' (p. 31). As DuBois says, 'each of the four principles is translated into a form of respect for a specific aspect of human nature'. Thus, morally relevant aspects of human beings and prescriptions about how one ought to treat human beings form the basis of the four principles.
DuBois explains how each principle has its foundation in human nature. All humans are capable of being harmed and benefited and, therefore, the principles of nonmaleficence and beneficence are applicable to humans in virtue of this capacity. Research may produce benefits in the form of certain goods, either for the human participants or for the wider community, but research may also involve harms, both physical and social ones, and these will also need to taken into account.
In so far as humans are capable of rationality and determining their own actions, then the principle of autonomy is applicable and, in the context of research, this will involve obtaining informed consent. There are, of course, many humans who are not capable of making autonomous choices and, in these instances, special protections are required, which will prevent such people from being harmed and exploited.
The principle of justice is based on a prescription as to how we ought to treat humans, that prescription being that all humans should be treated as equals. Thus, the principle of justice is related to the idea of equality and in the research context this will involve, for example, fair distribution of goods (p.33).
The remaining chapters (chapters four through ten) deal with applied issues, such as informed consent, decision-making capacity, harms and benefits, justice, confidentiality and conflicts of interests. All these chapters contain case studies that are thoroughly examined from within the theoretical framework (presented in the beginning chapters) to illuminate the relevant ethical issues, which arise in practice. DuBois analyses the cases with clarity, allowing the reader to understand how cases should be approached and how ethical principles and guidelines should be applied. Indeed, the subtleties of each case are taken into account; subtleties that even an experienced researcher or Institutional Review Board member may not be aware of.
Chapter ten is particularly informative, as DuBois shares his knowledge of the conflicts of interest that may cause ethical problems within mental health research. While various self-interested motivations may result in professional interests being given unjustifiably greater consideration than participant interests, DuBois pragmatically recognizes that researchers need to be motivated by something in order to engage in research and their motives may be altruistic or self-interested (p. 210). Researchers should be aware of motives that may influence their behavior (p.204). Practicing research ethics is a way of managing conflicts of interests justifiably.
While regulations provide legal protections for human participants and shape the behavior of professionals, rules and regulations, DuBois argues, should not be a substitute for ethics. Ethical decision-making in practice is not about following rules for their own sake, but about reflection and reasoning that takes account of morally relevant interests. As DuBois says, ethical reasoning 'should inspire us to go beyond the regulations in seeking to respect and benefit people in just ways' (p. 21). Indeed, those very regulations and policies, followed in research ethics, need to be defended on ethical grounds: 'We need to explain the ethical foundations of our rules in order to foster voluntary and reasonable compliance with regulations' (p. 21). Philosophical ethics is thus of utmost importance in the context of research ethics.
It must be said that DuBois' 'humanizing' of ethical principles (that is, the idea that human nature is the foundation upon which all ethical principles are derived) is suggestive of an underlying anthropocentric ethic; anthropocentrism being the view that all values are derivative from humans, and an ethic based solely on the interests of humans. Contrary to DuBois, it is not clear that characteristics inherent in human nature 'yield a theoretical foundation for principles' (p. 31).
While human beings may be the only species capable of moral agency, it does not follow that ethical principles are, therefore, derived from human nature or human characteristics. Other beings possess many of the characteristics from which ethical principles are supposedly derived. Nonhuman beings are also capable of being harmed and benefited and, indeed, some animals (it could be argued) possess a greater degree of rationality than some humans. Also, some enlightened thinkers would argue that the principle of equality should apply to nonhuman beings, and that their interests, as well as human interests, should be given equal consideration. Taking this into account, it is just not apparent that human nature is the foundation for the four ethical principles (that is, autonomy, nonmaleficence, beneficence and justice). While ethical principles should respect human interests, their application should not be restricted solely to human interests. However, 'humanizing' principles would, indeed, render such principles exclusive to human beings and exclude one large group of beings frequently used in mental health research, namely nonhuman ones. Thus, the 'humanized' principlism presented in this book may be too narrow as a universal ethic.
DuBois quite rightly states that certain people should be seen as 'vulnerable' and be given special protections in the research context. Vulnerable people may be more susceptible to harm and exploitation than other people. Such people include, for example, mentally disabled persons, as their decision-making capacity and communicative skills can often be minimal or nonexistent. This may result in them being subordinate to others who may disvalue their interests (p. 110-113). The Willowbrook study, in which mentally disabled children were deliberately infected with live hepatitis virus (p. 14), was one study that used vulnerable participants. DuBois devotes a section in chapter six to outlining the different ways people may be vulnerable and the corresponding risks that may result from such vulnerabilities (p. 112).
In exploring whether conducting research with mentally disabled children (such as those used in the Willowbrook study) is necessary DuBois suggests that one should ask whether an alternative course of action would achieve the same aim: 'For example, in the Willowbrook study, one might argue that more research could have been conducted with animals or that adult volunteers could serve as participants' (p. 54). However, while conducting such research with fully autonomous adults would remove the problem of consent, it seems that nonhuman beings satisfy criteria considered valid for special protections as vulnerable individuals or groups.
While the use of animals in research is the norm and, admittedly, this book focuses on human research, the above considerations regarding the humanization of ethical principles and the lack of awareness that animals may not always be ethical alternatives, do seem to indicate, or provide evidence of, an anthropocentric bias and the reader should perhaps be aware of this. Indeed, DuBois himself suggests that professionals may be unaware of their biases and that such biases may, unwittingly, be related to self-interested motives (p. 204). Promoting morally good behavior requires some form of self-awareness (p. 211, 220). Ethical analysis and reflection should seek to uncover any biases. And while DuBois explicitly states that his aim is to 'present a framework for ethical deliberation in human subjects research' (p. 21), an ethical framework for research conducted solely with humans need not be anthropocentric. (This is not to say that anthropocentrism can never be justified, but only that the reader should be conscious of value judgments that may influence any proposed ethic.)
Undoubtedly though DuBois is greatly aware of particular and general issues that arise in mental health research and, in spite of the above contentions, this book would be a valuable tool to all those professionals, working in the field of mental health, who have a genuine interest in ethical practice and professional ethics. As Dubois says, the book 'assumes they [the readers] want to know what is the right thing to do' (p. 220). The language used is accessible and DuBois avoids a high-level of technicality. There is an extensive index and references are to high quality journals that provide the reader with ample, well-researched further reading. Overall, Ethics in Mental Health Research is an informative and well-written book, providing excellent guidance for ethical decision-making in the practice of human mental health research.
© 2008 Rebekah Humphreys
Rebekah Humphreys earned a Master's Degree in Ethics and Social Philosophy at Cardiff University of Wales, U.K., and is nearing completion of a PhD in Philosophical Ethics.