Volume 23, Number 3, Fall 2012
ďPotential Subjectsí Responses to an Ethics Questionnaire in a Phase I Study of Deep Brain Stimulation in Early Parkinsonís DiseaseĒ
Stuart G. Finder, Mark J. Bliton, Chandler E. Gill, Thomas L. Davis, Peter E. Konrad, and P. David Charles
The Journal of Clinical Ethics 23, no. 3 (Fall 2012): 207-216.
Central to ethically justified clinical trial design is the need for an informed consent process responsive to how potential subjects actually comprehend study participation, especially study goals, risks, and potential benefits. This will be particularly challenging when studying deep brain stimulation and whether it impedes symptom progression in Parkinsonís disease, since potential subjects will be Parkinsonís patients for whom deep brain stimulation will likely have therapeutic value in the future as their disease progresses.
As part of an expanded informed consent process for a pilot Phase I study of deep brain stimulation in early stage Parkinsonís disease, an ethics questionnaire composed of 13 open-ended questions was distributed to potential subjects. The questionnaire was designed to guide potential subjects in thinking about their potential participation.
While the purpose of the study (safety and tolerability) was extensively presented during the informed consent process, in returned responses 70 percent focused on effectiveness and 91 percent included personal benefit as potential benefit from enrolling. However, 91 percent also indicated helping other Parkinsonís patients as motivation when considering whether or not to enroll.
This combination of responses highlights two issues to which investigators need to pay close attention in future trial designs: (1) how, and in what ways, informed consent processes reinforce potential subjectsí preconceived understandings of benefit, and (2) that potential subjects see themselves as part of a community of Parkinsonís sufferers with responsibilities extending beyond self-interest. More importantly, it invites speculation that a different paradigm for informed consent may be needed.