Confining choices: should inmates' participation in research be limited?

Historically, prisoners in the United States have served as an inexpensive and readily available source of human subjects for research. Coinciding with the civil rights movement, however, was an emerging conception of prisoners' rights that led to the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research being charged with investigating the use of prisoners as research subjects. The recommendations that evolved and the subsequent guidelines that have been implemented by the Department of Health and Human Services significantly curtail the use of prisoners as research subjects. While these measures are designed to protect inmates from the abuses of the past, of particular concern to many health care officials is exclusion of inmates from experimental HIV/AIDS and hepatitis treatments. This paper addresses whether the vulnerability of prisoners in the United States due to their incarceration is sufficient to prohibit them from participation in clinical trials that offer the possibility of life-saving treatment. It first outlines the evolution in moral thinking that has led to laws broadly prohibiting prisoners from biomedical research studies and then analyzes cases in the law to develop ethical arguments in support of the view that prisoners should be allowed to participate in clinical trials. The conclusion is that prisoners should be allowed to participate in such trials.