I have two short comments on this week’s readings. The first is regarding Fisher’s short case study of a trial participant with a progressive disease. Fisher uses an example of an older woman and her son to prove that even before the trial was consented to, the woman and her son had already agreed to it; they had made the decision even before speaking with the physician. Even though the physician explained that she would not personally benefit from the study, their minds were set to participate. Fisher says that it seems like the son had made up his mind that his mother should participate even before hearing all of the details. She says that informed consent gave the son new reasons to justify his mother’s involvement. But surely, if the son could imagine all of the potential benefits of the study prior to discussing anything with the physician, he could have just as easily imagined that there would be potential harms as well. Perhaps the son would not know the specific harms, but it is just as reasonable to believe that he could have considered that some sort of harm – including the trial not working on his mother at all – could take place. Therefore even if the mother and son had made up their minds prior to discussing the details of the trial, they may have realized that there are both potential harms and goods that could result.
A second comment is regarding the potential risk for alienating minority groups when recruiting subjects, mentioned by both Rajan and Epstein. I think this is a significant problem, given that minority groups like blacks and women continue to face these sorts of issues that compromise their dignity and threaten their freedom. This case seems to be a double-edged sword, since these minorities who were once refused participation in studies and are now in high demand (simply because of their prior refusal). An open question – is there a way to audit the process of consent, so that physicians leading the trial must give the same information to every potential subject?