Can a Research Subject Be Too Eager to Consent?

Sarah Orr

Dr. Lorraine Arangno

Introduction to Ethics 1020-002

May 12 2016

Can a Research Subject Be Too Eager to Consent?

Table of Contents

I. Summary of the Case Study: “Can A Research Subject Be Too Eager to

Consent?”

II. Statement of the Central Ethical Conflict

III. Statement of the Role and Philosophical Position

IV. The Principles of Faux Kantian Ethics

A. The Concept of Motivation

B. The Definition of Duty

C. Subjective Principles

D. Material Maxims

E. Hypothetical Imperative

F. Imperatives of Skill

G. Imperatives of Prudence

H. Objective Principles

I. Formal Maxims

J. The Categorical Imperative

V. Critique of Faux Kant’s Ethical Position

VI. Response to this Criticism

VII. Conclusion

Summary of the Case Study: “Can a Research Subject Be Too Eager to Consent?”

A twenty-one year old adult named Lila Goldberg was admitted into a hospital for

her anorexia and mental illness. She readily volunteered to participate in a research

study that would measure her conditions. She had signed a consent form approved by

the Institutional Review Board (IRB). The IRB were in charge of the procedures of the

project and they approved the consent form. However, the spinal procedures that she

would go though, would likely cause discomfort and infection.

Statement of the Central Ethical Conflict

The major ethical conflict was between Dr. O’Connor and Nurse Sharon Miller.

Nurse Miller thought that Lila’s illness was causing her to think irrationally. From Miller’s

perspective, anorexia patients were willing to harm themselves. Nurse Miller believed

that due to Lila’s mental condition, she should not participate in the study, as she was

concerned for Lila’s safety. From Dr. O’Connor’s perspective, Lila was competent

enough to participate in the case study. Having her in the study would potentially help

the researchers discover neurophysiological abnormalities in anorexia. Dr. O’ Conner

thought that Lila would be a good candidate for the project and wanted her to volunteer.

Unlike Lila and Dr. O’Connor, Nurse Millar and the IRB did not think that allowing Lila to

participate would be the best idea.

Statement of the Role and Philosophical Position

In regards to the case study presentation, I portrayed the role of Lila Goldberg.

Lila wanted to participate in the case study and was willing to go through the procedure,

even if it causes her discomfort and possibly harm. Philosopher Immanuel Kant states

that every rational being has a natural right. Based on what Kant states, Lila has a

natural right to pursue her happiness because it is beneficial for the greater good.

The Principles of Faux Kantian Ethics

In order for one to understand why Kant would agree with my position, one needs

to understand Kant’s ethical position in some detail. Immanuel Kant was a metaphysical

moralist. One of the goals of metaphysical moralists is to categorize duties and values.

Questions that were asked were “What is duty?” and “What ought I do to?” Kant was

concerned with determining what makes an act right or wrong. From Kant’s Concept of

Motivation, people are motivated by reason alone and ought to do the right thing

because it is right.

In Groundwork for the Metaphysics of Morals, Kant states “Duty is the necessity

to act out of reverence to the moral law.” “Necessity” refers to a requirement and

“reverence” is a deep respect for the law. The moral law describes respect for the rights

of all human beings unless they threaten to harm one another. Author Robert Johnson

states “In Kant’s terms, a good will is a will whose decisions are wholly determined by

moral demands…the Moral Law” (2004). Kant states “Good will is that will which is

motivated to act for the moral law, discovered inside of us.” Kant says “Two things fill

me, the starry heavens above me and the moral law within me.” There are different

ways to determine whether an action is right or wrong.

Kant states that “Objective principles are true for all rational agents.” The two

kinds of objective principles are the Hypothetical Imperative and Categorical Imperative.

According to Kant, the Subjective Principles are propositions that guide behavior. A

maxim is a principle, upon which a person wills to act. Material Maxims are formulated

as conditional statements. They explain cause and effect, “if X, then Y.” These maxims

are then tested by the Hypothetical Imperative, which refers to logical cause and effect.

According to Robert Johnson “A hypothetical imperative is a command that also applies

to us in virtue of our having a rational will” and it requires us to “exercise our wills in a

certain way” (2004). The Hypothetical Imperative states that any rational agent who

desires some end, must necessarily will the means to that end” (Arangno, 2016). For

Lila, she must act upon her will to be a part of the project by participating in the project

and talking to Dr. O’Connor and Nurse Millar. Conditional statements, also called

material maxims are tested against the Hypothetical Imperative. In other words, Lila’s

desire, inclination, or self-interest to participate are tested against an endless cycle of

cause and effect: If X, then Y, if Y, then Z and so on. The self-interests of Lila, Nurse

Millar, Dr. O’Connor and the IRB must be tested by the hypothetical imperative to be

use that they are reasonable.

The two types of Hypothetical Imperatives are Imperatives of Skill and

Imperatives of Prudence. Imperatives of Skill “express a means for obtaining a desired

goal” and Imperatives of Prudence are “general rules for obtaining happiness” (Kant’s

Ethics, n.d). Kant says that a moral person is a happy person but moral duty is separate

from happiness. People must pursue happiness at the right time and right place. In this

case, Lila wants to pursue her happiness by participating in the project. However, she

signed the papers that Dr. O Connor gave her. As a result of signing the papers, Lila is

also doing it for the research as a moral duty. However, there are other concepts that

needs to be addressed.

Formal Maxims are formulated declarative statements: “Do/Don’t do X.” Take

action or do not take action under no conditions. These maxims are then tested by the

Categorical Imperative, which determines a person’s will to act. Robert Johnson quotes

Kant and states that the Categorical Imperative describes duty to the moral law and

“commands us to exercise our wills in a particular way, not to perform some action or

other” (Johnson, 2004). The Categorical Imperative is the ultimate test for formal

maxims. The formal maxims are declarative statements of what a person ought to be

doing. In this case, the decision to allow Lila to participate would be tested against the

four formulas of the Categorical Imperative.

First, the Principle of the Law of Nature or Universalizability says to take action

only if it can be beneficial to all rational agents. The Principle of Universalizability says

universalize one’s formal maxim. It is saying “If I can do X, than everyone ought to do

X.” Second, the Principle of Ends values the respect of persons. It states that humans

are Ends to themselves, and are not to be used as means to ends. Third, the Principle

of Autonomy says, be a friend to yourself, discover your talents and pursue intellectual

virtues, moral virtues and creativity. There is a struggle between what one wants to do

and what one ought to do. Next, the Kingdom of Ends Formula is defined as a

“systematic union of different rational beings under common laws” (Johnson, 2004).

Kant says that the aim of this formula is for people to act on “principles which could earn

acceptance by a community of fully rational agents each of whom have an equal share

in legislating these principles for their community” (Robert Johnson, 2004). Finally, the

Formula of End Itself says an action is moral if one does not use it as a means to an

end for one’s own benefit. This leads to a debate on whether Lila should be allowed to

participate and whether her motivation is reasonable.

Critique of Faux Kant’s Ethical Position

What may be good for the majority may cause harm or a feeling of rejection to

the minority. In this case, while the case study would likely provide information for a

possible cure, it is not the right thing to do if it puts Lila’s life in danger. Sharon Miller

says that Lila wants to participate and she is being influenced by her illness. Another

philosopher, Hillel said “If I am not for myself, then who shall be for me? But if I am for

myself alone, then what am I?” In Lila’s case, if she is not for herself, no one else would

be. However, since she only has her interests in mind, then she is not living up to her

potential Kant states “In order for an act to be moral, it must be done for the sake of

duty and never out of a sense of inclination, desire, or self-interest.” Dr. Connor’s goal is

to discover abnormalities in anorexia that could not only help people in need, but also

support his job and reputation. Dr. Connor only wants Lila to volunteer out of his self-

interest. Therefore, to keep her safe, Lila should not be able to participate in the case

study.

Response to this Criticism

From Dr. O’Connor’s position, Lila wanted to volunteer for the case study and

she was competent enough to do so. Having her in the study would be a great

opportunity for the researchers and doctors to discover any abnormalities in anorexia.

That information could lead to a cure for the illness in the future. Doing this case study

would be a benefit for the greater good of society. As Kant stated “All human beings

have the right to pursue happiness” (Arangno, 2016) and this includes Lila. Allowing Lila

to participate would be beneficial to the greater good by providing results from her case

study that could reveal future treatments for anorexia. Even though, the procedure

might harm her, it is still her right.

Conclusion

In conclusion, the story of Lila Goldberg will continue to cause debate in medical

ethics. The ethical solution would be to hold off on the project until Lila is fully

competent enough. Lila should get extra support from her family and hospital

advocates. Although Lila read the forms that Dr. O’Connor gave her, she was too eager

to participate and did not thoroughly read them. Nurse Miller should help Lila view

herself as valuable, and also respecting her choice. Dr. Connor should not view Lila

only as a means to his end goal of finding a cure, even though it is for the greater good.

In the roleplay, Millar told Dr. O’ Connor that Lila was not a statistic, but a human being.

Finally, the IRB should carefully analyze the approval forms and make sure that the

risks are known. The moral dignity of the patient outweighs the probability of a research

project.

Works Cited

Author unknown. “The Categorical Imperative.” The Internet Encyclopedia of Philosophy. 2001. Web. Retrieved March 31 2016 from http://www3.nd.edu/~rbarger/categorical-imperative.html

Author unknown. (n.d). “Kant’s Ethics.” Retrieved April 30 2016 from http://users.wfu.edu/hhardgra/kanteth.html

Arangno, Lorraine. (2016, March-April). “Kant Principles.” University of Colorado, Colorado Springs. April 2016. Lecture.

Hastings Center Journal of Biomedical Ethics: Can A Research Subject Be Too Eager to Consent?

Hauptli, Bruce W. “Lecture Supplement on Kant’s Foundations for the Metaphysics of Morals.” 2013. Web. Retrieved March 31 2016 fromhttp://www2.fiu.edu/~hauptli/KantsMetaphysicofMoralsLectureSupplement.htm

Johnson, Oliver A. Reath, Andrews. “Ethics: selections from classical and contemporary writers.” (11th ed.) Cengage Learning. Library of Congress. Boston, MA. 2012, 2007, 2004. Print.

Johnson, Robert, (2004, February 23). “Kant’s Moral Philosophy”, The Stanford Encyclopedia of Philosophy (Summer 2014 Edition), Edward N. Zalta (ed.), Retrieved April 29 2016 from http://plato.stanford.edu/entries/kant-moral/

Kant, Immanuel. “Foundations of the Metaphysics of Morals.” Ethics: Selections from Classical and Contemporary Writers. Eds. Johnson, Oliver A., and Andrews Reath. Boston: Wadsworth, 2012. 181-207. Print.