The ethics of conducting a co-operative inquiry with vulnerable people.

BACKGROUND: Mental health services users have been calling for greater participation in clinical research. Participation in this context means research 'with' rather than 'on' groups of people. Conducting a co-operative inquiry involving the participation of vulnerable individuals as co-researchers, in particular those with a history of mental health problems, places an obligation on researchers to articulate and justify sound ethical procedures. AIMS: The aim of this paper is to consider how the ethical issues encountered when conducting participative research with vulnerable people can be addressed in the implementation of a co-operative inquiry with users of mental health services.
METHOD: The study was based on personal reflection and a critical review of associated literature obtained from a database search using Boolean logic.
FINDINGS: The findings, presented under the headings of the four prima facie moral principles, suggest the need for researchers using participative approaches to demonstrate the humanistic attributes required for engaging and working with people over a period of time. These include building and maintaining trusting relationships, assessing competence to participate, managing interpersonal and group dynamics and making complex collaborative decisions about participants' continued participation in a study.
CONCLUSIONS: When using a co-operative inquiry approach involving vulnerable individuals, researchers need to demonstrate clearly how a balance between autonomy and paternalism will be achieved, how risks will be anticipated and managed and how fairness will be maintained throughout all procedures. Researchers using participative approaches need to have developed a level of personal insight and self-awareness through access to supervision which focuses on sources of unintended manipulation and interpersonal dynamics that may arise at the inception of a study and throughout its course. Researchers and ethics committees have a shared responsibility to ensure that vulnerable people are appropriately engaged to maintain the advancement of user knowledge which informs nursing practice.