Can Involuntarily Admitted Patients Give Informed Consent to Participation in Research‪?‬

The article argues that a functional approach is ethically better than a categorical approach in deciding whether involuntarily admitted patients have the capacity to give informed consent to participation in research. Congruent with current South African laws, a functional approach requires that a patient's capacity to give informed consent to participation in research should be assessed clinically rather than assumed by virtue of his/her belonging to a category of legal admission status. Concerns about protection against exploitation may cause a categorical approach to appear attractive, but these concerns can be addressed deliberately through a functional approach without attracting the infringements of rights and entitlements of patients that are brought about by a categorical approach. Researchers in psychiatry, sponsors of psychiatric research and research ethics committees are confronted with an ethical question, viz. whether patients admitted involuntarily to a psychiatric hospital can give informed consent to participate in research. Some studies resort to an exclusion criterion that precludes these patients from participation in research. This article compares two approaches, and I argue that a functional approach is ethically preferable to a categorical approach to this question. A categorical approach predicates that people should be considered incapable by virtue of their belonging to a certain category, for example, being involuntarily admitted to a psychiatric hospital. In contrast, a functional approach requires that incapacity should not be assumed by virtue of a patient's belonging to any one category (e.g. the category of having been involuntarily committed to hospitalisation), but instead it allows that a patient may be incapable of deciding about hospitalisation yet be capable of making other decisions such as giving informed consent to participate in research.