Research Participation and Financial Inducements

Payments are different things to different people. To a homeless person, a guarantee of shelter and food is payment; to someone ghting a disease, treatment that might result in alleviation or a cure constitutes payment; to the impoverished student, maybe money is all that counts. What is important to understand is that motivation to participate in research can be varied and multifaceted and cannot be reduced to a single framework of monetary “payment. ” Christine Grady (2001) sets out to examine whether payment for research participation can either be coercive or act as an undue inuence, thus affecting informed consent. She decides that payment is not coercive according to her literal and potentially limited interpretation of the denition of coercion, “since the offer of money is not a threat of punishment or harm, but rather an offer. ” Similarly, undue inuence, she argues, only occurs on rare occasions with offers of money. As long as the offers remain temperate and in line with payment for other forms of unskilled work, payment should not constitute an excessive inuence. The difference between coercion and undue inducement is, as Grady points out, subtle, which has led to the terms being used synonymously. She deals with this by discarding coercion altogether as being extraneous to her argument and instead focuses on “undue inducements. ” The difference between coercion and undue inducement for the purpose of the present argument is analagous to that which in contract law identies two major obstacles to achieving autonomous choice: “the law of duress” and “the law of undue inducements” (Macklin 1981). Duress inuences free choice through compelling, threatening pressure, whereby other options are invalidated or portrayed as comparatively worse, but undue inuence entices people to participate in research with promises and rewards “against their better judgment. ”1 Although Grady does acknowledge that payment need not only include money, she argues throughout her paper with a one-dimensional approach towards coercion. According to her reasoning, if money itself cannot coerce (by virtue of the fact that it does not present a direct threat), then it cannot be deemed coercive. However, prior to the offer of money, the stage has often been set for a situation rife with all the necessary elements of coercion. If the perceived harm of not accepting the money is deemed to be greater than that of doing so, then the situation underlying the potential “solution” of money is coercive. Therefore, money or good healthcare or whatever it is that the subject is lacking become potentially coercive instruments in the hands of the researchers by providing the “only” choice or alternative. What makes something coercive is not just the perceived way out of the situation but the situation prior to the offer of a way out. A broader denition of coercion is “to deprive a man of freedom” (Berlin 1969, 121). Coercion is often phrased in terms of a lack of choice, a dearth of alternatives, but even where choices exist, not all choices are equally free (130). As Grady rightly observes, people “attracted to research by money . do have the freedom to refuse” (2001). However, what circumstances in these people’s lives would tip the balance in favor of taking money for something they would not normally do? What motivates a person in India