In “When Prisoners Are Victims” (The Chronicle Review, October 6), Allen M. Hornblum inaccurately characterized the recent recommendations by the Institute of Medicine’s Committee on Ethical Considerations for Revisions to the Department of Health and Human Services Regulations for Protection of Prisoners Involved in Research, on which we served. He suggests that the committee recommended reducing safeguards for prisoners, when the truth is the opposite.
The committee concluded that existing federal regulations provide inadequate protection for prisoners and need improvement. Current regulations apply to only a few federal agencies and those private institutions that voluntarily adopt them. As a result, many studies are not now governed by any rules and receive no independent review to assess their ethical appropriateness.
To further complicate matters, there has never been a national repository of all research projects involving prisoners, and thus there is no reliable basis upon which to quantify how many studies involving prisoners have been completed or are in process. Thus, many prisons across the country may be engaged in research of which the federal government is unaware.
There has been an almost fivefold increase in the prison population since the 1970s, with a proliferation of different types of correctional settings, including probation, house arrest, community service, halfway houses, boot camps, and traditional correctional facilities. Only about 2 percent of the nearly seven million people in the criminal-justice system in 2004 were incarcerated in prisons or jails. The rest do not receive protection under federal regulations. The committee thus recommended a broadening of the definition of the term “prisoner” to include people in virtually every correctional setting.
An additional important consideration is the increasingly disproportionate part of the prison population made up of women, racial minorities, and persons with mental disabilities, communicable diseases, and histories of substance abuse. Many of these groups have traditionally been underserved by our health-care system. Moreover, correctional health care often has too little equipment or money to provide adequate care.
Subjects’ consent could hardly be meaningful if the only avenue to adequate health care were conditional upon participation in research projects. For that reason, the committee required, as a prerequisite to research involving prisoners, an existing system that gives prisoners prompt access to decent health-care services.
It must be remembered that research not only imposes burdens and risks upon participants, it can also confer benefits, including the potential for improved health and well-being. And with the opening of otherwise closed institutions of prisons and jails to outside health professionals and other types of researchers — including epidemiological, sociological, and psychological — operational transparency and mutual understanding are likely to increase.
With those considerations in mind, in consultation with experts from wide-ranging disciplines, the committee strengthened protections for prisoners who choose to participate in research. We redefined the term “prisoner” and established universal, consistent standards of protection so that safeguards based on sound ethical values apply to all research with prisoners, whether publicly or privately sponsored. The committee also called on Congress to create a comprehensive national database that tracks all studies involving prisoners, and urged the creation of a robust system of national oversight.
But it also needs to be recognized that much important research involving prisoners has nothing to do with the kinds of shameful studies that worry Mr. Hornblum. Epidemiological, sociological, psychological, educational, and other types of studies are essential if we are ever going to improve our correctional system — especially the conditions under which prisoners are held — and prisoners’ chances to succeed after they are released. Nationally, more than 600,000 prisoners are released every year.
These issues are of great importance, especially as they concern some of the least-powerful Americans. Mr. Hornblum’s perspective was valuable to the committee and has relevance to the continuing debate. But absolute prohibitions of research based upon the sordid history of prisoner exploitation are not warranted. We believe that the committee’s recommendations provide an ethically sound basis for research that will improve conditions for existing and future prisoners.
This Counterpoint was also signed by the other members of the committee.
Lawrence O. Gostin is a professor of law at Georgetown University and chair of the Institute of Medicine’s Committee on Ethical Considerations for Revisions to the Department of Health and Human Services Regulations for Protection of Prisoners Involved in Research. Michael S. Hamden is a member of the committee and executive director of North Carolina Prisoner Legal Services Inc., in Raleigh.
http://chronicle.com Section: The Chronicle Review Volume 53, Issue 11, Page B20