Question: The basis of respect for all subjects whether they are diverse in culture, disabled, elderly, young, old etc. the precept of respect emphasizes the importance of individual autonomy. In the efforts of research it is the duty of the researcher to honor the choices of a competent individual to exercise their free will having self- determination and to act voluntarily to participate in the scientific research. (making an informed decision about whether or not to participate in a research study) Performing research with individuals with various behaviors or mental disorders can present challenges in terms of the impact on patient's ability to exhibit autonomy and his/her capacity for decision-making. Clients with mental disabilities for one can or may hinder consenting or the ability in making decisions. Some conditions overt or subtle cognitive functions could interfere with comprehension and understanding that raises questions of competence. (Fulford,& Howsa, 1993). Participants of research that are unable to give consent, the issues with the inability to provide consent can raise problems with the efforts of research. In most cases mentally disabled clients are vulnerable participants, therefore it is the participants assent, not merely the dissent that must be ordinarily considered valid because in the long run the lack thereof can cause a number of potentially problematic cases in the efforts of research. The one major problem is the client inability to understand. Per the Mental Health act of 1983 and the Code of Practice (21) are silent on the topic of research of these specific parties.

The Royal College of Psychiatrist guidelines suggest that dissenting patients should always be excluded from research whether they are competent or not. (Fulford,& Howsa, 1993). While involuntary mental health treatment is covered by the Mental Health Act, there is a possibility that procedures in research with an incompetent adult (assent or dissenting) possibly be illegal. Although, " avoiding such research is not a justified ethical response as it is also the right of all persons to avail of the best treatment, to participate in research and to contribute to the establishment of best treatments. It is untrue and stigmatizing to assume that all psychiatric research "entails greater risk and has less potential benefit than research in other areas of medicine."(Vaz & Srinivasan, 2014) It is vital that the researcher be aware that clients that are incapable of meaningful consent, can be because the conventionalities of research are not all one way. To proceed without consent though can be ethically hazardous. A good informed consent practice in general is by working with clients that have cognitive impairment and very limited capacity to making decision. In order for the participant to give consent for treatment or research, the formative way to obtain information is by providing small and essential information in an easy way to help the participant understand. This is done by using an iterative process that will help with comprehension and recall. (Vaz & Srinivasan, 2014) this method has been noted as a good informed consent practice.

I believe it is good standards to follow the three principles of (knowledge, necessity and benefits), including referral to a research ethics committee that can be a procedural safeguard. The researcher should be prepared to deal with any difficulties of valid consenting that may be the result of a client psychopathology. In research the experimental design should incorporate proposals that cover both general communication (use of appropriate language, repetition, a time for questions and answers). The overall process is ethical as well as heuristic affecting the way the client understands the nature of the research procedure, in the long run it may affect the results achieved.

Fulford, K. W., & Howse, K. (1993). Ethics of research with psychiatric patients: principles, problems and the primary responsibilities of researchers. Journal of Medical Ethics, 19(2), 85-91.

Vaz, M., & Srinivasan, K. (2014). Ethical challenges & dilemmas for medical health professionals doing psychiatric research. The Indian Journal of Medical Research, 139(2), 191-193.