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Therapeutic appropriation: a new concept in the ethics of clinical research
  1. Rosalind McDougall1,
  2. Dominique Martin2,
  3. Lynn Gillam1,
  4. Nina Hallowell3,
  5. Alison Brookes1,
  6. Marilys Guillemin1
  1. 1Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  2. 2School of Medicine, Deakin University, Geelong, Victoria, Australia
  3. 3Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  1. Correspondence to Dr Rosalind McDougall, Centre for Health Equity, Melbourne School of Population and Global Health, Level 4, 207 Bouverie St, University of Melbourne, VIC 3010, Australia; rmcdo{at}unimelb.edu.au

Abstract

Ethical concerns about therapeutic misconception have been raised since the early 1980s. This concept was originally described as research participants' assumptions that decisions relating to research interventions are made on the basis of their individual therapeutic needs. The term has since been used to refer to a range of ‘misunderstandings’ that research participants may have. In this paper, we describe a new concept—therapeutic appropriation. Therapeutic appropriation occurs when patients, or clinicians, actively reframe research participation as an opportunity to enhance patients' clinical care, while simultaneously acknowledging the generalised research aims. To illustrate the concept of therapeutic appropriation, we draw on data from an interview study which we conducted to investigate the experiences of patients and general practitioners involved in clinical trials in primary care. We argue that therapeutic appropriation has two key elements: comprehension that the research project is not necessarily aiming to benefit participants and the deliberate use of incidental features of the research for personal therapeutic benefit of various kinds. We conclude that therapeutic appropriation is a useful concept that refines understanding of potential ethical problems in clinical research, and points to strategies to address them.

  • Clinical Ethics
  • Primary Care
  • Research Ethics
  • Informed Consent

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Footnotes

  • Contributors RM, LG and MG conducted the interviews. All authors were involved in analysis of the data and the drafting of the paper.

  • Funding University of Melbourne (Research Collaboration Grant).

  • Competing interests None declared.

  • Ethics approval University of Melbourne Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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