Prisoners in Medical Research: Consent, Incentive and the Confined Body

Many thanks to Ebru Ustundag for alerting me to this recent paper arising from a national study led by Dr. Flora I. Matheson, a research scientist at St. Michael’s Hospital’s Centre for Research on Inner City Health, Toronto, Canada. The paper, published in the American Journal of Public Health, draws attention to the use of prisoners in Canada’s correctional system for medical and behavioural research, and in particular to the variety of policies and practices which surround the use of incentives for prisoners to take part in such research.

The paper points out that although prisoners are considered a vulnerable population in Canada, there is no specific regulation for ethical considerations for research involving prisoners, in terms of the use of incentives (anything offered to participants, monetary or otherwise, for participation in research). The authors point out the complications in offering incentives to prisoners: i.e. that for some, incentives could act as an undue inducement which could affect the voluntariness of consent; that offering incentives to nonoffenders but not to offenders could be seen as discriminatory; that some could argue that since prisoners are being ‘punished’ for breaking the law, they should not be ‘rewarded’ in any way for participation in research; and that providing incentives to offenders who meet research eligibility criteria (e.g. age, gender) but not to those who are not eligible, could create resentment within the prison environment. The paper concludes by suggesting ways forward for policy development in Canada to ensure effective and equitable engagement between researchers and the prison population, and an improved code of ethics for this population.

Whilst drawing attention to a particular issue of incentives and consent, this paper highlights in a broader sense the potential effects of confinement of the prisoner body; i.e. that confinement of the body places the body in a vulnerable position in relation to those who have a use to which it can be put. As the authors point out, ‘in history, offenders have been used in a variety of medical and behavioural studies without a properly informed consent process, often with little choice over their participation’ (Matheson et al 2012, 1438). Extreme examples, of course, include Nazi experimentation on thousands of concentration camp prisoners without their consent, and the recent revelations that American PoWs in Japan were apparently dissected alive. The bodies of dead prisoners have commonly been utilised for dissection and anatomical research: a 2007 Japanese study into the sources of cadavers for dissection by medical students found that in the mid Edo era, the bodies of executed prisoners were used to study internal body parts. Later, unclaimed bodies, including those from prisons, were used for dissection.

The disenfranchisement of prisoners apparently extended to the use of their bodies after death; according to research conducted by Ross Jones, in 1862, when the first Australian medical school was established in Melbourne, corpses were in such short supply that the Victorian Parliament passed the Anatomy Act to legalise the collection and dissection of cadavers. At the time, the inmates of the main benevolent asylum in North Melbourne feared that after they died, their bodies would be taken, without consent and used by medical students. They set up a petition against the Act demanding their bodies not be sent to the university but their concerns were ignored. In the same year, the Electoral Act  disenfranchised any person receiving charity in a public institution, and from then on, inmates had effectively no say in the disposal of their bodies. Although many advocates agitated about this inequity and argued for institutionalised Australians to be given the same rights as other citizens, the provision wasn’t discarded in Victoria until 1975.

This gory history of live experimentation and cadaver dissection is a backdrop to contemporary debates about the embodiment of imprisonment. Criminologist Azrini Wahidin‘s work explores the embodied nature of imprisonment, considering the particular ways in which prison time is inscribed upon the ageing imprisoned body, and the ways in which prisoners seek to deploy agency to resist the carceral control of the prison. For carceral geographers, considering imprisonment in this way opens a space for conceptualising  the experience of imprisonment as inherently embodied, drawing on scholarship in feminist geography which recognises both the mutually constitutive relationship between bodies and spaces, and a variety of bodily subjectivities (e.g. Johnson 2008). Bodies are understood as sites of  ‘textual inscription’  which shapes identities and social relations as well as the conceptual and actual spaces in which bodies move. The body, always in the process of becoming through the experiences of embodiment, is corporeally inscribed by imprisonment, in that the corporeal inscriptions acquired during incarceration act to construct bodily subjectivities which can stigmatise and disadvantage prisoners both during confinement and after release.

Returning to the Canadian example, participation in medical and behavioural research to which prisoners may consent, and for which they may or may not be offered incentives, could be viewed as enabled or encouraged by the carceral prism in which prisoners’ bodies are held during confinement, and also as a form of corporeal inscription of incarceration. Thankfully ethical regulations governing research in prisons are strict, and access procedures include detailed discussion of issues of consent, incentive and dissemination of information to participants. However, the thorny methodological and ethical issue of what constitutes ‘informed consent’ in a prison context remains, whether the research in question involves potentially risky medical research, or apparently benign questionnaire survey…