Vulnerability And Distributive Justice

To do research with a nursing home population solely for the convenience it presents for the researcher raises questions of distributive justice or fairness. Putting a vulnerable population at risk for the benefit of some other group can be unethical. Nontherapeutic research, not reasonably expected to provide medical benefit to vulnerable subjects, might appear unethical; but even the calculation of risks and benefits in the nursing home environment is complex. Rigorously insulating nursing home populations from risk can ignore other human needs and deprive them of stimulation, social involvement, and the opportunity to contribute to society, features already frequently lacking in the lives of nursing home residents. ''Such participation in the human community should not be automatically withheld from a whole class of persons in the name of protecting them from exploitation'' (Cassel, 1988). The opportunity for involvement should be considered in this cost-benefit analysis, and its value should be considered in relation to the nursing home resident's unique situation. It must, however, be used in good faith; as risk increases and the capacity to consent is diminished, that justification becomes less reasonable.

We should also consider studies that are especially promising in their potential to improve nursing home living. Such studies, by their nature, may have to involve members of the population they are intended to benefit. The vulnerability of the nursing home population should not by itself prevent that research. Research into the diseases that result in nursing home admission, into optimal nursing home practices or into conditions such as decubiti, incontinence, environmentally induced depression, and nosocomial infection will benefit the nursing home population as a whole, even if not all subjects will individually receive the benefits. The question of whether the nursing home population may ethically be recruited for such research is distinct from whether an individual resident may be recruited. Whether an individual resident should participate is still a function of the informed consent process, which still is especially complex in the nursing home.

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