How Females Keep Male Hoverfly Visual Neurons from Distraction

Background: Previous research on informed consent for research in psychiatric patients has centered on disorders that affect comprehension and appreciation of risks. Little has been written about consent to research in those subjects with Borderline Personality Disorder, a prevalent and disabling condition. Discussion: Despite apparently intact cognition and comprehension of risks, a borderline subject may deliberately choose self-harm in order to fulfill abnormal psychological needs, or due to suicidality. Alternatively, such a subject may refuse enrollment due to transference or the desire to harm him or herself. Such phenomena could be precipitated or prevented by the interpersonal dynamics of the informed consent encounter. Summary: Caution should be exercised in obtaining informed consent for research from subjects with Borderline Personality Disorder. A literature review and recommendations for future research are discussed. Background Decision-making capacity in psychiatric patients has been the topic of past research [1]. However, psychiatric disorders considered in such research are most often the psychotic and cognitive disorders [2]. This makes sense, as informed consent is traditionally thought to hinge upon comprehension [3]. However, such a viewpoint presupposes a subject that, understanding relative risks and benefits of a proposed action, will usually act in a way that maximizes benefit and minimizes harm to the self. Any deviation from this self-preserving pattern of behavior in the potential research subject is usually thought to result from altruism or such obviously coercive circumstances as financial reward, lack of other access to care, the perception that health care will be withdrawn without participation, etc. However, what about people that persistently and intentionally harm themselves? A large subpopulation of psychiatric patients suffer pathology which centers around a lifelong tendency to make what appear to others to be bad decisions. They may persistently seek out victim roles and manipulate others to harm them. They may make repeated suicide attempts, or compulsively cut themselves. Can it be considered ethical to draw blood from someone who consented because she has a psychological need to see herself bleed? Borderline personality disorder (BPD) is a prevalent, chronic, disabling, and treatmentresistant condition. It affects approximately 2% of community dwellers and 20% of psychiatric inpatients [4]. Although randomized clinical trials of both psychotherapeutic and psychopharmacologic treatments for BPD are relatively common [4,5], a literature search on consent Published: 10 May 2007 BMC Medical Ethics 2007, 8:4 doi:10.1186/1472-6939-8-4 Received: 4 January 2007 Accepted: 10 May 2007 This article is available from: http://www.biomedcentral.com/1472-6939/8/4 © 2007 Dew; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.