People with learning disability sometimes display challenging behaviour. This can be managed by use of antipsychotic medication or behavioural therapy or both. There is no solid evidence, however, that these therapies are safe and effective. A randomised controlled trial of antipsychotic medication has been proposed to deliver such evidence. However, this presents difficult issues in the ethics of research with learning disabled people. In particular, is a trial the most efficient and fairest way to evaluate practice in this area? This paper reviews the clinical situation, gives the rationale for the trial, and analyses the ethical arguments for and against such a trial.
- Learning disability
- antipsychotic medication
- randomised trial
- challenging behaviour
- research ethics
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Richard Ashcroft is Sir Siegmund Warburg Lecturer in Medical Ethics, Medical Ethics Unit, Department of Primary Health Care and General Practice, Imperial College of Science, Technology and Medicine, London. Bill Fraser is Professor of Psychiatry of Learning Disability, Welsh Centre for Learning Disabilities Clinical Studies, University of Wales College of Medicine, Cardiff. Michael Kerr is Senior Lecturer and Honorary Consultant Psychiatrist at the Welsh Centre for Learning Disabilities Clinical Studies. Dr Zahir Ahmed is Specialist Registrar and Honorary Lecturer in Learning Disability at the Welsh Centre for Learning Disabilities Clinical Studies.
This paper was prepared on the basis of work commissioned by the UK NHS Health Technology Assessment Programme (pharmaceutical panel).
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