Words shape our decisions. Giving informed consent to participate in research is no exception. Certain metaphors make us more likely to want to participate and others drive us away. This is because of the associations attached to metaphors.
For example, consider the research ‘guinea pig’. This metaphor was coined in 1913 by George Bernard Shaw, and has been frequently used to suggest medicine is prioritizing research knowledge over patient care. Researchers often avoid it when describing participation in clinical trials. People who understand participating in research as being a ‘guinea pig’ are less likely to participate in research. This is particularly true for research involving children. People tend not to want to be experimented on like a guinea pig.
Another metaphor influencing the decision to participate in research is randomization as a ‘gamble’. In clinical trials, participants may be randomly selected to receive a treatment, or randomly selected to not receive a treatment. This allows researchers to compare the two groups to see if the treatment is effective. Participants are hesitant to take the ‘gamble’, or flip a coin, to determine which group they will be in. People tend not to want to take a gamble on their life.
Metaphors can also persuade people that certain actions are the right decision. This is called the framing effect. When a metaphor is used to describe a problem, people are more likely to choose a solution that uses the same metaphor. For example, people who are told that mental illness is a ‘chemical imbalance’ are more likely to choose medication to correct this imbalance. Those who think mental illness is ‘inappropriate and unwanted thoughts’ may not be so quick to jump to the same chemical solution.
This leads to a moral dilemma. Researchers have an obligation to explain the research process to participants in a way they will understand. Metaphors are an excellent way to make unfamiliar concepts clear – they may be the best way. But the specific metaphors researchers use are not neutral. They do more than convey information. Metaphors also persuade. How can important information be shared without accidentally also persuading someone to participate, or not, in research? Does ‘inviting’ people to participate in research frame them as guests who don’t actually belong in the research process? Does asking for ‘volunteers’ imply the results of the research will always be used for good? When language can communicate and persuade, how do we balance the two?
This dilemma is not unique to research. Metaphors influence decisions from whether to buy one product over another, to whether countries decide to go to war. They shape government policies and influence government spending. And they make us second guess which health decisions are safe. When language can be used as either a weapon or a door, an invitation or a barrier, we need to reflect on what metaphors are making clear, and what they are leaving out.
Do metaphors used in research tell the whole story? No, they don’t. For example, a ‘guinea pig’ hides how much research, evidence, and ethical consideration, go into designing research studies. It obscures participants’ agency in the research process. It neglects that human beings can voluntarily choose to help others. To give truly informed consent, we need both sides of the story and to question the implications of our metaphors.
Photo by Dan Barrett on Unsplash
