title: Public's approach to surrogate consent for dementia research: cautious pragmatism.
abstract: OBJECTIVE
  To describe how members of the older general public deliberate with one another in finding solutions to the dilemma of involving persons with decisional incapacity in dementia research.
  
  
  METHODS
  One hundred sixty persons age 50 years and older who participated in an all-day deliberative democracy session on the ethics of surrogate consent for dementia research. The deliberative democracy day consisted of both extensive, interactive education with experts in clinical research and ethics, as well as small group deliberations.
  
  
  METHODS
  Audiotaped small group deliberations were transcribed and analyzed and the main thematic elements were coded.
  
  
  RESULTS
  During deliberation, participants acknowledged the limitations of advanced research directives and discussed ways to improve their use. Although there was consensus about the necessity of surrogate consent, the participants recognized potential pitfalls and looked for ways to safeguard the process. Participants supporting surrogate consent for research emphasized societal and individual benefits, the importance of assent, and trust in surrogates and the oversight system. Other participants felt that the high risk of some research scenarios was not sufficiently offset by benefits to patients or society.
  
  
  CONCLUSIONS
  Members of the older general public are able to make use of in-depth education and peer deliberation to provide reasoned and informed opinions on the ethical use of surrogate consent for dementia research. The public's approach to surrogate consent is one of cautious pragmatism: an overall trust in science and future surrogates with awareness of the potential pitfalls, suggesting that their trust cannot be taken for granted.
authors.affiliation: Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor.
authors.forename: Raymond
authors.initials: R
authors.lastname: De Vries
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Ryan
authors.forename: Aimee
authors.initials: A
authors.lastname: Stanczyk
authors.forename: Paul S
authors.initials: PS
authors.lastname: Appelbaum
authors.forename: Laura
authors.initials: L
authors.lastname: Damschroder
authors.forename: David S
authors.initials: DS
authors.lastname: Knopman
authors.forename: Scott Y H
authors.initials: SY
authors.lastname: Kim
mesh_terms: D016223:Advance Directives / Q000941:ethics; D003704:Dementia / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011639:Public Opinion; D020458:Third-Party Consent / Q000941:ethics*