Deliberative assessment of surrogate consent in dementia research

published online 02 March 2010.

Abstract

Background

Research involving incapacitated persons with dementia entails complex scientific, legal, and ethical issues, making traditional surveys of layperson views on the ethics of such research challenging. We therefore assessed the impact of democratic deliberation (DD), involving balanced, detailed education and peer deliberation, on the views of those responsible for persons with dementia.

Methods

One hundred and seventy-eight community-recruited caregivers or primary decision-makers for persons with dementia were randomly assigned to either an all-day DD session group or a control group. Educational materials used for the DD session were vetted for balance and accuracy by an interdisciplinary advisory panel. We assessed the acceptability of family-surrogate consent for dementia research (“surrogate-based research”) from a societal policy perspective as well as from the more personal perspectives of deciding for a loved one or for oneself (surrogate and self-perspectives), assessed at baseline, immediately post-DD session, and 1 month after DD date, for four research scenarios of varying risk-benefit profiles.

Results

At baseline, a majority in both the DD and control groups supported a policy of family consent for dementia research in all research scenarios. The support for a policy of family consent for surrogate-based research increased in the DD group, but not in the control group. The change in the DD group was maintained 1 month later. In the DD group, there were transient changes in attitudes from surrogate or self-perspectives. In the control group, there were no changes from baseline in attitude toward surrogate consent from any perspective.

Conclusions

Intensive, balanced, and accurate education, along with peer deliberation provided by democratic deliberation, led to a sustained increase in support for a societal policy of family consent in dementia research among those responsible for dementia patients.

Keywords: Alzheimer's disease, Informed consent, Deliberative democracy, Bioethics, Research ethics, Surrogate-based research, Impaired decision-making capacity

a Bioethics Program, University of Michigan, Ann Arbor, MI, USA

b Center for Behavioral and Decision Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA

c Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

d Division of Law, Ethics, and Psychiatry, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA

e Department of Neurology, Mayo Clinic, Rochester, MN, USA

f Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA

g Health Services Research and Development, Ann Arbor Veterans Administration Medical Center, Ann Arbor, MI, USA

h Dementia Collaborative Research Centre, Queensland University of Technology, Brisbane, Queensland, Australia

i Division of Acute, Critical, and Long-Term Care Programs, School of Nursing, University of Michigan, Ann Arbor, MI, USA

Corresponding author. Tel.: 734-936-5222; Fax: 734-936-8944.

PII: S1552-5260(09)02055-X

doi:10.1016/j.jalz.2009.06.001

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