Informed Consent of Very Sick Subjects in Nigeria

Abstract

This article highlights a number of ethical challenges I face in obtaining informed consent from very sick subjects with suspected pulmonary tuberculosis (TB). Some of the subjects with TB have an associated human immunodeficiency virus (HIV) infection. From my experience in administering informed consent and health surveys, I found the subjects to be generally mentally stable but physically exhausted. Many of the very sick subjects cough excessively and cannot tolerate a 45-minute conversation with the study staff in order for them to administer consent and conduct a survey after the routine clinical evaluation. In this situation, the administration of a qualitative consent that preserves the subject's right and autonomy becomes a challenge.

Keywords:

• human immunodeficiency virus (HIV)
• informed consent
• Nigeria
• very sick
• vulnerable subjects
• tuberculosis

ACKNOWLEDGMENTS

My sincere thanks to the Institute of Human Virology University of Maryland Fogarty International Research Program (Grant no. 5D43TW001041-09) for the training and funding supports for my Ph.D. thesis work; the management and staff of the National TB and Leprosy Training Center in Zaria, Nigeria, and Dr. Adil Shamoo for the useful feedback in writing this article.