Silva Diego S, Matheson Flora I, Lavery James V
Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, B.C, V5A 1S6, Canada.
Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Canada.
BMC Med Ethics. 2017 Apr 27;18(1):31. doi: 10.1186/s12910-017-0189-6.
Despite the growing recognition for the need to improve the health of prisoners in Canada and the need for health research, there has been little discussion of the ethical issues with regards to health research with prisoners in Canada. The purpose of this paper is to encourage a national conversation about what it means to conduct ethically sound health research with prisoners given the current realities of the Canadian system. Lessons from the Canadian system could presumably apply in other jurisdictions.
Any discussion regarding research ethics with Canadian prisoners must begin by first taking into account the disproportionate number of Indigenous prisoners (e.g., 22-25% of prisoners are Indigenous, while representing approximately 3% of the general Canadian population) and the high proportion of prisoners suffering from mental illnesses (e.g., 45% of males and 69% of female inmates required mental health interventions while in custody). The main ethical challenges that researchers must navigate are (a) the power imbalances between them, the correctional services staff, and the prisoners, and the effects this has on obtaining voluntary consent to research; and (b), the various challenges associated to protecting the privacy and confidentiality of study participants who are prisoners. In order to solve these challenges, a first step would be to develop clear and transparent processes for ethical health research, which ought to be informed by multiple stakeholders, including prisoners, the correctional services staff, and researchers themselves.
Stakeholder and community engagement ought to occur in Canada with regards to ethical health research with prisoners that should also include consultation with various parties, including prisoners, correctional services staff, and researchers. It is important that national and provincial research ethics organizations examine the sufficiency of existing research ethics guidance and, where there are gaps, to develop guidelines and help craft policy.
尽管人们越来越认识到有必要改善加拿大囚犯的健康状况以及开展健康研究的必要性，但对于加拿大囚犯健康研究中的伦理问题却鲜有讨论。本文旨在鼓励就加拿大当前体制下开展符合伦理道德的囚犯健康研究意味着什么展开全国性讨论。加拿大体制中的经验教训想必可应用于其他司法管辖区。
任何关于加拿大囚犯研究伦理的讨论都必须首先考虑到原住民囚犯比例过高的问题（例如，22% - 25%的囚犯是原住民，而他们在加拿大总人口中所占比例约为3%）以及患有精神疾病的囚犯比例很高（例如，45%的男性和69%的女性囚犯在羁押期间需要心理健康干预）。研究人员必须应对的主要伦理挑战包括：（a）他们与惩教服务人员和囚犯之间的权力不平衡，以及这对获得研究的自愿同意产生的影响；（b）保护作为研究参与者的囚犯的隐私和保密性所面临的各种挑战。为了解决这些挑战，第一步是制定清晰透明的健康研究伦理程序，该程序应由包括囚犯、惩教服务人员和研究人员自身在内的多个利益相关者提供信息。
在加拿大开展囚犯健康研究伦理方面，利益相关者和社区应参与其中，这也应包括与各方进行协商，包括囚犯、惩教服务人员和研究人员。国家和省级研究伦理组织审查现有研究伦理指导的充分性并在存在差距的地方制定指导方针并协助制定政策非常重要。
