title: Therapeutic appropriation: a new concept in the ethics of clinical research.
abstract: Ethical concerns about therapeutic misconception have been raised since the early 1980s. This concept was originally described as research participants' assumptions that decisions relating to research interventions are made on the basis of their individual therapeutic needs. The term has since been used to refer to a range of 'misunderstandings' that research participants may have. In this paper, we describe a new concept-therapeutic appropriation Therapeutic appropriation occurs when patients, or clinicians, actively reframe research participation as an opportunity to enhance patients' clinical care, while simultaneously acknowledging the generalised research aims. To illustrate the concept of therapeutic appropriation, we draw on data from an interview study which we conducted to investigate the experiences of patients and general practitioners involved in clinical trials in primary care. We argue that therapeutic appropriation has two key elements: comprehension that the research project is not necessarily aiming to benefit participants and the deliberate use of incidental features of the research for personal therapeutic benefit of various kinds. We conclude that therapeutic appropriation is a useful concept that refines understanding of potential ethical problems in clinical research, and points to strategies to address them.
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Rosalind
authors.initials: R
authors.lastname: McDougall
authors.affiliation: School of Medicine, Deakin University, Geelong, Victoria, Australia.
authors.forename: Dominique
authors.identifier: 0000-0001-9363-0770
authors.initials: D
authors.lastname: Martin
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Lynn
authors.initials: L
authors.lastname: Gillam
authors.affiliation: Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Nina
authors.initials: N
authors.lastname: Hallowell
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Brookes
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Marilys
authors.initials: M
authors.lastname: Guillemin
mesh_terms: D035843:Biomedical Research / Q000941:ethics*; D032882:Comprehension; D003210:Concept Formation; D003695:Delivery of Health Care; D032984:Ethics, Research; D006297:Health Services Accessibility; D006801:Humans; D007258:Informed Consent; D033182:Intention; D011320:Primary Health Care; D012107:Research Design; D035842:Research Subjects; D011795:Surveys and Questionnaires; D055990:Therapeutic Misconception
keywords: Clinical Ethics; Informed Consent; Primary Care; Research Ethics