Sense and nonsense: an essay on schizophrenia research ethics

In this essay, the authors select topics from the current debate on the eth ics of schizophrenia research. Accepting competent and voluntary informed c onsent as essential for most projects, the authors discuss the relation of diagnosis to decisional capacity, the respective roles of psychosis and cog nitive impairments in decisional capacity, and whether impairments in capac ity can be remediated. The roles of investigator, external agent? patient s ubject, and family or surrogate in the informed consent process are reviewe d. A lack of understanding of the treatment of persons with schizophrenia h as distorted and inflamed public discussion of issues such as 'withholding treatment'. A standard, based in common sense, is proposed: for viewing pro tocols; for allowing autonomy and altruism despite diagnostic class; and, f or a meaningful discussion of what is meant by and what should be done abou t 'risk without direct benefit' protocols. (C) 1999 Elsevier Science B.V. A ll rights reserved.