Schizophrenia research: Ethical questions

Abstract

Although the ethical issues concerning schizophrenia research have evolved considerably over the last decade, there are many questions that remain only incompletly resolved.

Ethical concerns involved in schizophrenia research have been raised from the doubts about the competency of the potential research participants to valid informed consent. Another issues addressed in this presentation are drug discontinuation, medication-free intervals and placebo control groups in research on schizophrenia, problem of financial payments to participants in clinical research, consequences of exclusion of potentially suicidal patients from biological and therapeutical research, question of research approaches to prodromal and early phase of schizophrenia and discrimination against the individuals with the potential genetic risk for schizophrenia.

Recent studies suggest that the strongest predictors of decisional incompetency of patients with schizophrenia are cognitive impairment and severity of negative symptoms. On the other hand, age, education, severity of positive and depressive symptoms and level of insight have only minimal predictive value. We can also say that the presence of diagnosis of schizophrenia is not enough to indicate that a patient is unable to give valid consent to research participation.

Although we must confirm that many questions of etiology, prevention or treatment of schiziphrenia are not satisfactory resolved just because we are not able to realize ethically acceptable studies, we must hope that development in this new area of schizophrenia research will improve the risk/benefit ratio of research approaches and bring clearly defined values, guidelines and standards.