Incentivization and the moral problem of involuntary consent in medical research

Incentivization and the moral problem of involuntary consent in medical research
Victor Chidi Wolemonwu
History and Philosophy of Medicine, 18 January 2023
Open Access
The legal and moral permissibility of clinical research entails that researchers must secure the voluntary, informed consent of prospective research participants before enrolling them in studies. In seeking the consent of potential participants, researchers are also allowed to incentivise the recruitment process because many studies would fail to meet enrollment goals without a financial incentive for participation. Some philosophers and bioethicists contend that the use of incentives to secure consent from research subjects is problematic because it constitutes undue inducement and a coercive offer. Some proponents of this view are Ruth Macklin (1981, 1989) and Joan McGregor (2005). Macklin claims that it is ethically inappropriate to pay research subjects. The payment is likely to coerce the research subject, thereby violating the ethical requirement on the voluntariness of research participation. Also, such offers can prompt subjects to lie, deceive or conceal information that, if known, would disqualify them as participants. For McGregor, incentives could be undue and coercive because they make offerees better off relative to their baseline as well as constrain them to accept the offer of incentives as the only eligible choice or option. I argue that coercive offers are distinct from undue inducement. Coercive offers are essentially morally objectionable because by making people accept an offer through threats for the sake of some interests or ends, the offeror vitiates the offeree’s capacity to make informed, voluntary, and rational decisions and choices. I further claim that the quantity of an incentive does not render an inducement undue. I contend that the only condition under which incentives are regarded as an undue inducement and as such vitiates an agent’s voluntary consent is if they are offered through deceptive or manipulative means.

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