Unethical Manipulation of Participants in Clinical Trials

Abstract

I will argue that the relationship between the clinician scientist and the participant in the ACTG 076 trials involved unethically manipulative elements. My question of unethical manipulation examines the relationship between the clinician scientist and the participant. My first chapter establishes manipulation as follows, ‘A manipulates B if and only if A motivates B to make a decision or perform an action that bypasses B’s rational capacities by means of deception, emotional pressure, or exploitation of B’s ego depleted state.’ I argue that manipulation is prima facie unethical because it violates one’s autonomy. In the second chapter I examine the concerns of illness, gender roles, pregnancy, and HIV status, which can cause ego depletion and increase the participants’ vulnerability to manipulation. After analysis, I conclude that, although none of these elements can be eliminated as concerns for the clinician scientist, if they are not adequately accounted for, the clinician scientist has unethically manipulated the participant to enter and remain a part of the trial. I suggest that an adequate account would involve special consideration of how these vulnerabilities interact within the specific context of the trial. My third and final chapter will relate my conclusions to the current and upcoming research that is actively incorporating pregnant women as participants.