Conflicts of Interest

1
Conflicts of Interest

• Ethics in Mental Health Research

2
Conflicts of Interests What are they?

• Conflicts of interests arise when one or more
  potentially motivating interest or benefit (e.g.,
  knowledge, money, employment) might conflict with
  another interest that the individual is expected
  to pursue as a professional (e.g., providing
  clinical care to patients)

3
What ethical issues do COIs raise?

• Beneficence multiple commitments may be good
  insofar as they allow multiple goods to be
  achieved
• Nonmaleficence conflicts of interest may harm
  trust or interfere with professional duties
  leaving needs unmet
• Autonomy managing COIs may require people to
  eliminate conflicts of interest not disclosing
  COIs leaves clients unable to choose risks
• Fairness Often COIs present conflicts between
  stakeholders with equally legitimate but
  competing needs or interests

4
Why are COIs so difficult?

• They are everywhere, unavoidable, and not always
  bad
• We may be blind to the influence certain benefits
  have on us. Cognitive dissonance may lead to
  self-serving messages and dereliction of duty
• Identifying and disclosing COIs may be half the
  battle
• We may ignore the impact of appearances, harm
  to trust
• Oversight processes are particularly important in
  this regard

5
Sources of conflicts

• Conflicts may arise between
• Multiple interests or commitments inherent in one
  professional role
• Multiple roles generating multiple interests
• Multiple beneficiaries of professional actions
• Self-interests vs. professional interests or
  commitments (classic)

6
Multiple interests inherent in a role

• Examples of multiple interests in research
• To gain knowledge
• To satisfy requirements of funding agency
• To stay within budget
• To publish
• To benefit the community of participants or
  larger society

7
Multiple roles generating multiple interests

• Researcher-clinician
• Researcher-teacher
• Researcher-employee
• Researcher-funding recipient
• Researcher-program evaluator
• Researcher-member of society
• Sales Lavin (2000)

8
Multiple beneficiaries of professional actions

• Research staff
• Funding agency
• Society / people in target population
• Participants with competing needs
• Researcher
• Institution

9
Self-interests vs. professional interests or
commitments

• Researchers may gain
• Financially
• Socially (e.g., prestige)
• Intellectually

10
How should conflicts of interest be dealt with?

• Several options exist all require identifying
  COIs!
• Eliminating conflict (e.g., foregoing payment,
  stepping down from a role)
• Disclosing conflict (e.g., to participants, to
  colleagues or superior)
• Introducing intermediaries (e.g., consent
  monitor)
• What other approaches might be sensible?