Consent and coercion: Research with involuntarily treated persons with mental illness or substance abuse

Persons can be subject to involuntary treatment for mental illness or substance abuse in a variety of circumstances. The ability of such persons to give a valid informed consent for research often has been called into question, because the coercive nature of the treatment is thought to impair the voluntariness of their decision making. A careful consideration of the nature of coercion from a “moralized”; perspective focuses attention on two elements that determine the acceptability of consent: the fairness of the proposal to which consent is sought, and the moral baseline from which the proposal is made. Even when coercion is not present, disproportionate rewards offered for participation in research can impair the voluntariness of consent, as can the unintended effects of the social structure of the system in which the research is taking place. When coercion, defined as a moralized concept, is not present, however, and other conditions do not substantially impair voluntariness, consent to research legitimately may be sought from involuntarily treated populations.

Keywords:

• Coercion
• informed consent
• research
• involuntary treatment
• decision making
• competence