When Is It Ethical for Physician-Investigators to Seek Consent From Their Own Patients?

Classic statements of research ethics advise against permitting physician-investigators to obtain consent for research participation from patients with whom they have preexisting treatment relationships. Reluctance about “dual-role” consent reflects the view that distinct normative commitments govern physician–patient and investigator–participant relationships, and that blurring the research–care boundary could lead to ethical transgressions. However, several features of contemporary research demand reconsideration of the ethics of dual-role consent. Here, we examine three arguments advanced against dual-role consent: that it creates role conflict for the physician-investigator; that it can compromise the voluntariness of the patient-participant’s consent; and that it promotes therapeutic misconceptions. Although these concerns have merit in some circumstances, they are not dispositive in all cases. Rather, their force—and the ethical acceptability of dual-role consent—varies with features of the particular study. As research participation more closely approximates usual care, it becomes increasingly acceptable, or even preferable, for physicians to seek consent for research from their own patients. It is time for a more nuanced approach to dual-role consent.     

Affective small stories – Witnessing an ‘ideal’ instance of knowledge mobilization

In this short reflective intervention, I utilize an innovative narrative format to document my account of being an invited academic witness for the Canadian House of Commons as a graduate student. Drawing upon layered forms of critical witnessing, I utilize five small stories to consider this seemingly ideal instance of sexual health knowledge mobilization that spanned academic, government, media, and social-profit sectors. I braid complex, messy threads to capture my affective wayfinding through the complicated institutional processes involved in the generation, representation, critique and control of sexual knowledge. Highlighting how this work can be more broadly applicable to graduate students and emerging scholars in related disciplines, I note how my critical witnessing is intertwined with social, economic and political conditions present in Canada and elsewhere. This work additionally illustrates experimental self-inquiry that disrupts distinctions between researcher/subject/seer and participant/object/seen.