Inducements for medical and health research: issues for the profession of nursing

Abstract

Inducements, incentives, reimbursements and payment to subjects for participation in research projects raise many practical, professional and philosophical issues for nurses. Nurses are enjoined, either formally as research co-participants or informally as patients' professional carers, in any research which involves their patients. This role inescapably brings significant ethical obligations, which include those of bioethical audit. A review of current international guidelines on reimbursement recommendations indicates that researchers select one of several paradigms which range from the 'commercial market model' of supply and demand to that of pure un-reimbursed altruism. In this latter, volunteers not only give their bodies and emotional commitment, but also sacrifice their time and convenience. Inducement is defined as the provision of resources or rewards which exceed the 'resource neutral' compensation for legitimate expense. If potential volunteers are truly free to make an informed choice to participate in research, no ethical compromise exists if inducements are offered; but by so doing both the research team and the volunteer patients have shifted the ethos of their research from caritas and altruism to one of a simple commercial relationship. Inducements are inappropriate when offered to those who are 'ethically captive' in the sense that autonomy of choice may be compromised. In contemporary nursing practice, research involvement is both frequent and desirable. A perspective of current debate about inducements for volunteering, including legal and ethical issues, empowers nurses to protect the patients or clients in their care.