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Why does informed consent fail? A discourse analytic approach.

David E Ness1, Scott F Kiesling, Charles W Lidz

  • 1Baylor College of Medicine, Houston, TX, USA. dness@menninger.edu

The Journal of the American Academy of Psychiatry and the Law
|September 22, 2009
PubMed
Summary

Informed consent interviews often fail due to communication breakdowns. Linguistic discourse analysis reveals how conversational elements and framing impact participant understanding and autonomous decision-making in research.

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Area of Science:

  • Medical Ethics
  • Linguistics
  • Clinical Research

Background:

  • Informed consent is crucial for ethical research participation.
  • Current methods often fail to ensure prospective subjects fully understand research.
  • Therapeutic misconception remains a significant challenge in informed consent.

Purpose of the Study:

  • To analyze failures in informed consent using linguistic discourse analysis.
  • To understand how conversational elements and discourse framing affect participant understanding.
  • To explore the extent to which subjects explore concerns relevant to research choices.

Main Methods:

  • Applied linguistic methods of discourse analysis to informed consent interview transcripts.
  • Analyzed elements of conversation and discourse framing.
  • Assessed subject's level of understanding, therapeutic misconception, and exploration of concerns.

Main Results:

  • Lapses and miscommunications in informed consent can be specifically identified through conversational elements and framing.
  • Discourse analysis provides a detailed, language-based understanding of consent process failures.
  • Identified specific linguistic patterns contributing to inadequate informed consent.

Conclusions:

  • Linguistic discourse analysis offers a valuable alternative to abstract or inferential approaches to studying informed consent.
  • Findings have implications for improving informed consent processes through targeted educational and research strategies.
  • Understanding the micro-level linguistic interactions is key to enhancing ethical research participation.