Introduction

Coercion

In his 1969 essay Coercion, Robert Nozick outlined an intuitive and compelling framework including necessary and sufficient conditions to identify instances of coercion. Nozick strayed from traditional definitions and established that i) coercion is primarily based on threats, not violence or force; ii) happens because the coercee has acquiesced to it; iii) focuses on the coercee’s psychology and consent instead of on action and what the coercer does (Anderson 2021). Nozick’s framework was influential and shaped many years of the discussion around coercion. 

Nowadays coercion is commonly defined as “a threat to violate someone else’s rights, or to fail to satisfy an obligation to them, in order to obtain compliance in situations where that person has no reasonable alternative but to comply.” (Largent et al 2017). Implications of coercion include that it diminishes the target’s autonomy, responsibility and freewill. Despite its many negative consequences most critics do not fully condemn coercion. Some have argued it is hardly imaginable to have a society where no authorized coercion occurred and coercion is often categorized into two groups: justifiable and unjustifiable (Wertheirmer and Miller 2008; Held 1972; Anderson 2021). In addition, while Nozick and later accounts define coercion as threats, some scholars have opposed this notion and introduced a framework of coercion that also accounts for it in the form of offers (Anderson 2021; Held 1972).

In relation to biomedical research, particularly the case of payment for research participation, there are concerns regarding the moral nature of such payments and their coercive role on research participants (Largent et al 2013; Halpern et al 2004; Lamkin and Elliott 2018). Largent et al (2013) found in an empirical study of IRB members that the caution over paying participant for research was justifiable, but warned against IRB “pseudo-paternalism.” Weithermer and Miller (2008) similarly argue in favor of a “rights-violating view” of coercion. Accordingly, cases of payment for research participation do not fall under the scope of coercion but may warrant ethical scrutiny as a form of undue inducement.

Undue Inducement

Undue Inducement encompasses a different ethical terrain. Not all inducement is undue, leaving unproblematic inducement aside, undue inducement deals with the relationship between the inducement and the subject’s response. Weithermer and Miller (2008) highlight that unlike coercion undue inducement involves decisional myopia and is rooted in a distorted judgement.  

Ezekiel Emmanuel (2005) critically condemned the charge of undue inducement in biomedical research as harmful and inadequate to the research enterprise. According to Emmanuel an inducement is only undue if and only if it involves: 1) an offered good; 2) an excessive offer; 3) poor judgement; and 4) the risk of serious harm. Based on this criteria, an undue inducement happens in situations when an offer is so great that it completely distorts one’s ability to think clearly and make reasonable decisions that a rational person would. This definition has been widely (but not universally) adopted in the literature. According to Emmanuel, speaking of undue inducement in biomedical research is like “nonsense on stilts,”  because of the requirement of “serious harm” it becomes nearly impossible to find given existing protocols of IRBs and RECs.

Largent et al (2017) also adopt Emmanuel’s definition however they critique it as over-expansive because IRBs are not infallible. Accordingly, Largent et al (2017) highlight that concerns with payments should rather focus not on paying participants but on not paying them enough. Consequences of inadequate payment can include risks of exploitation, risks due to recruitment shortfalls, and the overburdening of certain populations.

Lastly, the harm from undue inducement is not limited to serious risks to participants, it is also a risk for the data collection process and could disrupt the integrity of scientific research.

Assigned Readings

Wertheimer, A., & Miller, F. G. (2008). Payment for research participation: a coercive offer?. Journal of medical ethics, 34(5), 389–392. https://doi.org/10.1136/jme.2007.021857

Thesis: Authors argue that characterizing payment for research participation as coercive is misguided, that financial payments do not undermine consent and that it is best to investigate problematic cases of research payment under undue inducement.

Emanuel E. J. (2005). Undue inducement: nonsense on stilts?. The American journal of bioethics : AJOB, 5(5), 9–W17. https://doi.org/10.1080/15265160500244959

Thesis: The author argues against the use and charge of the term ‘undue inducement’ on the grounds it is inaccurate and inappropriate, instead they point towards the need to hold proper ethics review, clear and efficient consent procedures, and limit injustices in enrolment of participants.

Held, V. (1972). Coercion and Coercive Offers. In J. R. Pennock and J. W. Chapman (Eds.). Coercion (1st ed, chapter 4). Routledge. https://doi.org/10.4324/9781315081007

Thesis: The author explores different accounts and argues that coercion involves getting someone to do something against their will via force, violence, power, exercise of threats or offers and according to ‘degrees’ of constraint or inducement.

Reflection Points

Wertheimer and Miller (W&M) want to reject the idea that offers can ever be coercive. They reject several views that are associated with the idea of offers being coercive: 

  1. W&M reject the “motivates people to do something they would not otherwise do view of coercion.” What is their reason (counter example) to reject this view? 
  2. W&M reject the “no reasonable alternative view of coercion.” What are their reasons (counter examples) to reject this view?

What do you think of their counter examples/dismissal of the no reasonable alternative view of coercion? (In other words, evaluate this argument)

  1. W&M also reject the “vulnerability view of coercion.” What are their reasons (counter examples) to reject this view? 

What do you think of their counter examples/dismissal of the vulnerability view of coercion? (In other words, evaluate this argument)

  1. W&M put forth a “rights violating view of coercion.” 

Evaluate this view (especially does it work for research and clinical encounters). 

  1. W&M do admit that offers can be ethically problematic—not because of coercion, but because of “undue inducement.”

References and Additional Resources

Largent, E., Grady, C., Miller, F. G., & Wertheimer, A. (2013). Misconceptions about coercion and undue influence: reflections on the views of IRB members. Bioethics, 27(9), 500–507. https://doi.org/10.1111/j.1467-8519.2012.01972.x

Halpern, S. D., Karlawish, J. H., Casarett, D., Berlin, J. A., & Asch, D. A. (2004). Empirical assessment of whether moderate payments are undue or unjust inducements for participation in clinical trials. Archives of internal medicine, 164(7), 801–803. https://doi.org/10.1001/archinte.164.7.801

Lamkin, M., & Elliott, C. (2018). Avoiding Exploitation in Phase I Clinical Trials: More than (Un)Just Compensation. The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics, 46(1), 52–63. https://doi.org/10.1177/1073110518766008

Largent, E. A., & Lynch, H. F. (2017). Paying Research Participants: The Outsized Influence of “Undue Influence”. IRB, 39(4), 1–9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640154/

Anderson, S. (2021) SEP Coercion. Edward N. Zalta (ed.) The Stanford Encyclopedia of Philosophy  https://plato.stanford.edu/archives/sum2021/entries/coercion/