The ethics of research involving prisoners

A recent article in Medical News Today about whether Canadian prisoners should be paid to participate in research started me thinking about whether prisoners should be research subjects at all. One of the basic requirements for ethical research on human subjects is the freely given informed consent of the participants. Being a prisoner puts a person in conditions that make it very difficult to assure that the prisoner is able to make a truly voluntary and uncoerced decision about being a research subject. Adding a financial incentive as is discussed in the article could make it more difficult to be sure that a free and uncoerced decision was being made.

To help in thinking about whether any research with prisoners are subject should be allowed, I decided to look into the current US regulations regarding the use of prisoners as research subjects. The regulations of the National Institutes of Health and the Department of Health and Human Services are quite clear on what type of research is allowed when prisoners are the research subjects. The biggest concern is that prisoners might be coerced into being subjects in research that those who were not prisoners would not agree to participate in. The US federal regulations have addressed this by restricting research involving prisoners to include only research from which prisoners will benefit. This avoids prisoners being exploited for the benefit of others in society. The types of research that are allowed include research on the causes and effects of incarceration, studies of prisons as institutional structures and how that affects prisoners, research on conditions particularly affecting prisoners as a class, and research which has the intent of improving the health of the individual subject. The first two categories involve research on the penal system itself which could not be done without involving prisoners and should lead to benefits to prisoners from improvements in the penal system. The third seeks to improve the health of prisoners as a group, and the fourth seeks to improve the health of the individual prisoner who is a participant. Limiting research on prisoners to these categories greatly reduces the concern about exploiting prisoners for the benefit of others.

When we return back to the issue of paying prisoners to participate in research it makes a significant difference what type of research is being considered. The biggest problem with financial compensation of research subjects is the use of that compensation to coerce prisoners into agreeing to be subjects in research they will not benefit from and which others would not agree to participate in. Restriction of the research on prisoners to the categories currently allowed in the US eliminates that problem to a very large degree. Compensation of prisoners who volunteered to participate in research about the penal system would be appropriate to be compensated on an equal level with other activities that prisoners do which benefit the prison system as a whole. Compensation for participation in research designed to improve the health of the prison population as a whole can be seen to be appropriate as long as the risks are adequately controlled. Compensation would not be expected to be needed when the research was being done to benefit the individual prisoner. I do not know whether Canada has the same restrictions on what research can be done using prisoners as subjects, but if the restrictions are similar to those in the US it would seem that compensation of prisoners for participation in those limited types of research would not pose a significant ethical problem.

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Jon Holmlund, M.D.
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Jon Holmlund, M.D.

Informative post. I agree with the conclusions. I haven’t seen any research proposals including prisoners, yet, in my IRB job, and may never–we don’t get a lot of those. Clearly, for the first 3 categories Steve discusses, there’s a risk of undue influence based on the amount of compensation, and I agree that for the fourth, where the research offers the prospect of direct (not just indirect) benefit, compensation of the subject is likely to be moot. Of course, for prisoners, there is always a risk of coercion (entailing some sort of threat) on top of undue influence. (The military… Read more »