July 3, 2022

Do prisoners have a right to participate in clinical trials?

Prisoners are being unfairly excluded from taking part in potentially beneficial clinical research, argue researchers in the JME.

Prisoners are being unfairly excluded from taking part in potentially beneficial clinical research, on the grounds that it would be too difficult and expensive to do so, according to research in the Journal of Medical Ethics

The pendulum of clinical research on prisoners seems to be swinging back towards participation. In a sense the origins of bioethics are to be found in research on prisoners – in Nazi concentration camps in the 1940s. Revulsion at those atrocities led to the Nuremberg code stressing the importance of informed consent. Nonetheless, prisoners were still used for trials. During the 1970s, about 85% of all US phase-1 clinical trial were conducted on prisoners. The substances to which they were subjected ranged from perfume, soap and cosmetics to dioxin, psychological warfare agents and radioactive isotopes.

In the wake of a number of scandalous abuses, attitudes have changed – so dramatically, say the authors, that current guidance governing research in prisons nowadays in the UK is too ‘protectionist’ and restrictive. The strongest argument for prisoner participation in research, they say, is equity: prisoners should have access to the same healthcare and research opportunities as other citizens.

They also cite a moral argument:

“participants may benefit through the moral satisfaction of contributing to society. Research contribution can be regarded as a public good. As such, excluding prisoners denies them the opportunity to make the same moral contribution as free members of society, disengaging them from the wider moral community. Moreover, prisoners may particularly value this as a way ‘to redeem, atone and reconcile’.”

(It no accident that the words “to redeem, atone and reconcile” strike a religious note in an otherwise utilitarian essay. They ultimately came from a 1996 article in a journal called “Catholic Lawyer” in which they were used ironically.)  

Prisoners are a highly vulnerable group and in the past they were sometimes horribly exploited by researchers. Will this happen again? The authors are optimists. Times have changed: “Research is now subject to strict regulations, research governance and review, all of which act as safeguards against unethical research.” Surveys have shown that although prison life does influence a decision to participate, “it is questionable whether such influences constitute coercion”.

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