Brian B. Roberts

Psychiatric research ethics: an overview of evolving guidelines and current ethical dilemmas in the study of mental illness

The field of psychiatry has an opportunity to construct a more refined, perhaps more enduring understanding of the ethical basis of mental illness research. The aim of this paper is to help advance this understanding by 1) tracing the evolution of the emerging ethic for biomedical experimentation, including recent recommendations of the Presidents National Bioethics Advisory Commission, and 2) reviewing data and concepts related to compelling ethical questions now faced in the study of mental disorders. Empirical findings on informed consent, the ethical safeguards of institutional review and surrogate decision making, and the relationship between scientific and ethical imperatives are outlined. Psychiatric researchers will increasingly be called upon to justify their scientific approaches and to seek ways of safeguarding the well-being of people with mental illness who participate in experiments. Most importantly, psychiatric investigators will need to demonstrate their appreciation and respect for ethical dimensions of investigation with special populations. Further empirical study and greater sophistication with respect to the distinct ethical issues in psychiatric research are needed. Although such measures present many challenges, they should not interfere with progress in neuropsychiatric science so long as researchers in our field seek to guide the process of reflection and implementation.

Teaching medical students to discern ethical problems in human clinical research studies.

Purpose Investigators and institutional review boards are entrusted with ensuring the conduct of ethically sound human studies. Assessing ethical aspects of research protocols is a key skill in fulfilling this duty, yet no empirically validated method exists for preparing professionals to attain this skill. Method The authors performed a randomized controlled educational intervention, comparing a criteria-based learning method, a clinical-research- and experience-based learning method, and a control group. All 300 medical students enrolled at the University of New Mexico School of Medicine in 2001 were invited to participate. After a single half-hour educational session, a written posttest of ability to detect ethical problems in hypothetical protocol vignettes was administered. The authors analyzed responses to ten protocol vignettes that had been evaluated independently by experts. For each vignette, a global assessment of the perceived significance of ethical problems and the identification of specific ethical problems were evaluated. Results Eighty-three medical students (27%) volunteered: 50 (60%) were women and 55 (66%) were first- and second-year students. On global assessments, the criteria-focused group perceived ethical problems as more significant than did the other two groups (p < .02). Students in the criteria-focused group were better able than students in the control group (p < .03) to discern specific ethical problems, more closely resembling expert assessments. Unexpectedly, the group focused on clinical research participants identified fewer problems than did the control group (p < .05). Conclusions The criteria-focused intervention produced enhanced ethical evaluation skills. This work supports the potential value of empirically derived methods for preparing professionals to discern ethical aspects of human studies.

Ethics in Psychiatric Research

Controversy has arisen in recent years about the participation of psychiatric patients in questionably ethical research protocols. Consequently, academic psychiatrists have been called upon to enrich their understanding of the ethical aspects of research and to teach residents more intensively about these issues in scientific methodology. Toward these ends, the authors have assembled an extensive resource listing in the area of psychiatric research ethics. Articles were identified through MEDLINE and BIOETHICS LINE computerized searches and the authors’ review of relevant literature through 1996. Emphasis was placed on those pieces with special historical value, empirical studies, and papers that provide background on the current controversies in psychiatric research ethics. The references were organized into five logical categories. Based on the resource review, the authors briefly discuss areas related to research ethics that merit greater attention in academic psychiatry.

Clinical Ethics Teaching in Psychiatric Supervision

Supervision of psychiatric residents provides a natural context for clinical ethics teaching. In this article, the authors discuss the need for ethics education in psychiatry residencies and describe how the special attributes of supervision allow for optimal ethics training for psychiatry residents in their everyday encounters with ethical problems. Ethical decision making in clinical settings is briefly reviewed, and a 6-step strategy for clinical ethics training in psychiatric supervision is outlined. The value of the clinical ethics supervisory strategy for teaching and patient care is illustrated through four case examples.

Honorary Fellowship Awards and Professional Development in Psychiatry

Honorary fellowship awards are given each year by professional organizations in recognition of the achievements and future promise of psychiatric trainees. No data have been published to evaluate the characteristics of, or effects on, awardees. A 50-item instrument was developed to test four hypotheses. The confidential survey was mailed to award recipients identified by six major professional psychiatric associations. Data were analyzed by comparing responses with χ2 statistics and repeated measures multivariate analyses of variance. Responses from the award recipients from five of the organizations (N = 182, response rate = 55%) were analyzed. Fellowship awards were perceived as helpful to professional development. Certain fellowship-related experiences were seen as more important than others, and these varied as a function of the awarding organization and by gender. The awards had less importance than the recipients expected. Meeting with colleagues and leaders or mentors, prestige associated with the awards, networking, and learning about academic and organizational psychiatry were valued by the recipients. Enrichment of mentoring opportunities was identified as an area for improvement. The recipients described later involvement with professional organizations. Honorary fellowship award recipients represent a widely accomplished group of psychiatrists, who report their fellowship award experiences overall as beneficial to their career development. Perceived differences in fellowship programs should be interpreted in light of their varying goals, composition, and structures. Greater efforts to mentor awardees should be considered by fellowship programs.