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This chapter focuses on two specific populations of individuals often vulnerable in the conduct of research: children and prisoners. With children, prisoners, and other vulnerable populations, the challenge is to find the right balance between protection from abuse and the need to grant vulnerable populations access to participation in research. Necessary protections have two components: fair subject selection, and the specific care required to minimize wrongs to vulnerable persons once they are enrolled in research. As a group, prisoners are vulnerable due to their particular situation: being detained and therefore being deprived of the freedom to move freely. Several prison-related factors are relevant for ethical considerations about research involving prisoners. Studies designed to address health problems specific to a vulnerable population are needed to improve care for this very population, and often cannot be conducted on others.
This chapter focuses on the concept of patient consent for ansthesia for psychosurgery and electroconvulsive therapy (ECT) using the case of a 20-year-old patient with severe psychiatric disorders. Psychosurgery has a controversial history, in which medical, moral, social, and political considerations intermingle. The main ethical issues connected to these interventions involve the scientific validity of the therapy and its evaluation, the validity of patient consent, and the possibility of conflict between the interests of the patient and those of society, particularly in the case of dangerous or violent individuals. Psychosurgery raises fundamental questions, such as those linked to the definition of person and free will, concepts of dignity, integrity, and the validity of true consent. Ultimately, decisions regarding psychosurgical interventions and ECT must be made on a case-by-case basis, taking into account patient suffering and disability, and balancing these considerations with patient autonomy.
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