TRIRPP, ‘vulnerability’ and Beauchamp & Childress’ tenets of biomedical ethics

Beauchamp & Childress’ biomedical ethics framework remains the dominant approach through which the rights and wellbeing of potential participants are foregrounded in the research process (Attfield, 2020). There has been critique that the tenets of ‘autonomy’, ‘non-maleficence’, and ‘justice’ cannot adequately address differences in adversity among participants and the populations from which they are recruited without due attention to trauma in research design (Campbell 2019). TRIRPP is aligned with B&C’s framework in so far as it can be seen to operationalise elements of it. E.g. a trauma-informed approach can be understood as an operationalisation of the tenet of ‘non-maleficence’ (not doing harm) by it’s focus on avoiding and minimising re-traumatisation, while a resilience informed approach aligns with ‘beneficence’ (doing good) through promoting resilience in research participants, as well as promoting ‘justice’ by taking forward the right to participate in research through enhanced processes that offer an egalitarian focus on equal worth and fair opportunity among people (Ebberson et al. 2012) to access healthcare, participate in the research that directs its content and delivery, and transform aspects of their adversity.

This focus on justice is vital – research has historically privileged non-maleficence over justice, leading to populations of ‘therapeutic orphans’ often deemed too vulnerable for research due to perceived dependency, diminished decisional capacity or lack of self-protective resources (Levine et al. 2004). Happily, in the UK the concept of ‘vulnerability’ has been repositioned so that research approval processes hinge not on adequacy of provision for ‘vulnerable populations’ but on assessment of  ‘regulated activities’ that may cause vulnerability (NIHR, 2012).This represents a shift from conceptualising vulnerability as a quality residing in the individual to recognising it as a feature of research contexts that can be attenuated or avoided. This focus on research contexts as sites of empowerment, resilience and – unwittingly- as potentially traumatic or vulnerability inducing – is central to the TRIRPP approach.

 

Attfield R. Principlism, public health and the environment. Journal of Public Health. 2020.

Campbell R, Goodman-Williams R, Javorka M. A Trauma-Informed Approach to Sexual Violence Research Ethics and Open Science. Journal of interpersonal violence. 2019;34(23-24):4765-93.

Ebbesen M, Andersen S, Pedersen BD. Further development of Beauchamp and Childress’ theory based on empirical ethics Journal of Clinical Research and Bioethics. 2012:S6-e001.

Levine C, Faden R, Grady C, Hammerschmidt D, Eckenwiler L, Sugarman J. The limitations of “vulnerability” as a protection for human research participants. Americal Journal of Bioethics. 2004;4(3):44-9.

NIHR. The Research Passport: Algorithm of Research Activity and Pre-Engagement Checks Research in the NHS: HR Good Practice Resource Pack Version 3.0 London, UK: NIHR; 2012.

 

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