In the previous chapter we looked at the ethical problems that occur in situations where it is not possible, or sensible, to attain fully informed consent from research subjects. In the case of the saliva samples, the requirement for written consent could endanger the performance of the experiment. In the case of patients involved in research in emergency situations, the physical condition of the patient renders fully informed consent impossible. Though one can often explain emergency research to patients after the fact, but any explanation cannot make up for the lack of consent, or fulfil the requirement for informed consent.
In this chapter we will consider case studies in which the problem of the lack of consent is intensified. In the following case of challenging behaviour, the difficulties in satisfactorily resolving the consent problem are clearly evident. In the case of Alzheimer's disease presented at the end of the chapter, further problems are addressed which can arise due to the fundamental requirement of informed consent.
In addition, this chapter considers the extent to which research with cognitively impaired persons is ethically justified. This question will be discussed in the second article of this chapter.
by Richard Ashcroft5
People with learning disability sometimes display what is known as 'challenging behaviour'. Challenging behaviour has
5 The following paper is a modified version of Ashcroft, R., B. Fraser, M. Kerr and
Z. Ahmed 2001. Are antipsychotic drugs the right treatment for challenging
behaviour in learning disability: The place of a randomised trial. Journal of
Medical Ethics 27(5): 338–43 (with permission from the BMJ Publishing Group).