Informed consent in psychiatric research

Purpose of review Conventional concepts and procedures for informed consent in medicine and psychiatry are being challenged from several directions. In this review, publications in 2002 that deal with informed consent in psychiatry, both conceptual and empirical in type, are covered. The intention is to review publications dealing with clinical practice and with research, and to encompass contributions from the more general literature on informed consent that included psychiatric examples or were otherwise relevant to the field. Recent findings Little of value was published that had a bearing on the topic of informed consent in psychiatric clinical practice. Thus, this review deals with psychiatric research. The most useful articles tackled the following themes: the concept of voluntarism; consent from surrogates and 'substituted judgements'; and challenges to conventional informed consent processes from legal, economic, social and cultural viewpoints, including challenges from managed care, health services and genetic research and from evidence-based medicine. Several authors pointed to the lack of empirical data on these developments and on practices in informed consent generally, called for more research and suggested what the agendas and priorities of such research should be. Interestingly, empirical studies published in 2002 covered traditional concerns, such as decisional capacity or competence, rather than these larger, contextual issues. Summary The sphere of psychiatric research exists within multiple, dynamic contexts - legal, economic, social, and cultural. Although a number of authors made useful conceptual contributions relevant to the practice of informed consent, empirical research has lagged behind.