The idea that payment for research participation can be coercive appears widespread among research ethics committee members, researchers, and regulatory bodies. Yet analysis of the concept of coercion by philosophers and bioethicists has mostly concluded that payment does not coerce, because coercion necessarily involves threats, not offers. In this article we aim to resolve this disagreement by distinguishing between two distinct but overlapping concepts of coercion. Consent-undermining coercion marks out certain actions as impermissible and certain agreements as unenforceable. (...) By contrast, coercion as subjection indicates a way in which someone’s interests can be partially set back in virtue of being subject to another’s foreign will. While offers of payment do not normally constitute consent-undermining coercion, they do sometimes constitute coercion as subjection. We offer an analysis of coercion as subjection and propose three possible practical responses to worries about the coerciveness of payment. (shrink)

Recognising that offers of payment to research participants can serve various purposes—reimbursement, compensation and incentive—helps uncover differences between participants, which can justify differential payment of participants within the same study. Participants with different study-related expenses will need different amounts of reimbursement to be restored to their preparticipation financial baseline. Differential compensation can be acceptable when some research participants commit more time or assume greater burdens than others, or if inter-site differences affect the value of compensation. Finally, it may (...) be permissible to offer differential incentive payments if necessary to advance the goals of a study. We encourage investigators and Institutional Review Boards to think about whether to offer payment, in what amounts and for what purpose, and also to consider whether differential payment can help promote the scientific and ethical goals of clinical research. (shrink)

Controlled Human Infection Model (CHIM) research involves the infection of otherwise healthy participants with disease often for the sake of vaccine development. The COVID-19 pandemic has emphasised the urgency of enhancing CHIM research capability and the importance of having clear ethical guidance for their conduct. The payment of CHIM participants is a controversial issue involving stakeholders across ethics, medicine and policymaking with allegations circulating suggesting exploitation, coercion and other violations of ethical principles. There are multiple approaches to payment: (...) reimbursement, wage payment and unlimited payment. We introduce a new Payment for Risk Model, which involves paying for time, pain and inconvenience and for risk associated with participation. We give philosophical arguments based on utility, fairness and avoidance of exploitation to support this. We also examine a cross-section of the UK public and CHIM experts. We found that CHIM participants are currently paid variable amounts. A representative sample of the UK public believes CHIM participants should be paid approximately triple the UK minimum wage and should be paid for the risk they endure throughout participation. CHIM experts believe CHIM participants should be paid more than double the UK minimum wage but are divided on the payment for risk. The Payment for Risk Model allows risk and pain to be accounted for in payment and could be used to determine ethically justifiable payment for CHIM participants.Although many research guidelines warn against paying large amounts or paying for risk, our empirical findings provide empirical support to the growing number of ethical arguments challenging this status quo. We close by suggesting two ways (value of statistical life or consistency with risk in other employment) by which payment for risk could be calculated. (shrink)

Recognizing that offers of payment to research participants can serve various purposes—reimbursement, compensation, and incentive—helps uncover differences between participants that can justify differential payment of participants within the same study. Participants with different study-related expenses will need different amounts of reimbursement to be restored to their pre-participation financial baseline. Differential compensation can be acceptable when some research participants commit more time or assume greater burdens than others, or if inter-site differences affect the value of compensation. Finally, it may (...) be permissible to offer differential incentive payments if necessary to advance a study’s goals. We encourage investigators and Institutional Review Boards to think not only about whether to offer payment, in what amounts, and for what purpose, but also to consider whether differential payment can help promote the scientific and ethical goals of clinical research. (shrink)

Payment for research participation has raised ethical concerns, especially with respect to its potential for coercion. We argue that characterising payment for research participation as coercive is misguided, because offers of benefit cannot constitute coercion. In this article we analyse the concept of coercion, refute mistaken conceptions of coercion and explain why the offer of payment for research participation is never coercive but in some cases may produce undue inducement.

What I call ‘the standard view’ claims that IRBs should not regard financial payment as a benefit to subjects for the purpose of risk/benefit assessment. Although the standard view is universally accepted, there is little defense of that view in the canonical documents of research ethics or the scholarly literature. This paper claims that insofar as IRBs should be concerned with the interests and autonomy of research subjects, they should reject the standard view and adopt ‘the incorporation view.’ The (...) incorporation view is more consistent with the underlying soft-paternalist justification for risk-benefit assessment and demonstrates respect for the autonomy of prospective subjects. Adoption of the standard view precludes protocols that advance the interests of subjects, investigators, and society. After considering several objections to the argument, I consider several arguments for the standard view that do not appeal to the interests and autonomy of research subjects. (shrink)

The payments industry – the business of transferring value through public and corporate infrastructures – is undergoing rapid transformation. New business models and regulatory environments disrupt more traditional fee-based strategies, and new entrants seek to displace legacy players by leveraging new mobile platforms and new sources of data. In this increasingly diversified industry landscape, start-ups and established players are attempting to embed payment in ‘social’ experience through novel technologies of accounting for trust. This imagination of the social, however, is (...) being materialized in gated platforms for payment, accounting, and exchange. This paper explores the ambiguous politics of such experiments, specifically those, like Bitcoin or the on-demand sharing economy, that delineate an economic imaginary of ‘just us’ – a closed and closely guarded community of peers operating under the illusion that there are no mediating institutions undergirding that community. This provokes questions about the intersection of payment and publics. Payment innovators’ attenuated understanding of the social may, we suggest, evacuate the nitty-gritty of politics. (shrink)

We largely agree with Grimwade et al ’s1 conclusion that challenge trial participants may ethically be paid, including for risk. Here, we add further arguments, clarify some points from the perspective of economics and indicate areas where economists can support the development of a framework for ethically justifiable payment. Our arguments apply to carefully constructed and monitored controlled human infection model trials that have been appropriately reviewed and approved. Participants in medical studies perform a service. Outside the domain of (...) research participation, there is nearly universal agreement that workers providing a service should be compensated fairly, and that work involving more discomfort and risk should be compensated more generously. Accordingly, labour regulations impose floors, not caps on compensation. Caps, even if intended to protect against undue inducement, also raise concerns about illegal price-fixing that disadvantages workers. Such limits on payment for egg donors have successfully been challenged in court.i Moreover, caps on compensation may harm everyone at risk of infection, not just potential participants. Insufficient compensation may impede the recruitment of enough suitable subjects, for example, when representativeness of the subject sample is required. Delays in vaccine development not only prolong disruption of social, educational and economic activity but also lead to excess infections and deaths. Unlike paid CHIM participants, individuals exposed to such infection do not accept it voluntarily, are not compensated for it, and are unlikely to receive the level of medical supervision afforded to closely monitored CHIM participants. Payment caps can lead to attempts to circumvent the regulation. For example, many countries …. (shrink)

The presumption is that a broker executing a stock trade for a retail investor will get the investor the best possible price execution for the transaction. In fact, the broker often sells the retail investor’s trade to an intermediary for cash payment. The broker’s motivation to generate dealer profits seems to overcome the broker’s fiduciary responsibility to obtain the best execution price for the customer, raising ethical questions. Purchasers and internalizers of order flow in the market may cause prices (...) quoted on the NYSE to deteriorate, making all investors worse off. (shrink)

The burdens of resource constraints in publicly funded healthcare systems urge decision makers in countries like Sweden, Norway and the UK to find new financial solutions. One proposal that has been put forward is co-payment—a financial model where some treatment or care is made available to patients who are willing and able to pay the costs that exceed the available alternatives fully covered by public means. Co-payment of this sort has been associated with various ethical concerns. These range (...) from worries that it has a negative impact on patients' wellbeing and on health care institutions, to fears that co-payment is in conflict with core values of publicly funded health care systems. This article provides an overview of the main ethical issues associated with co-payment, and ethical arguments both in support of and against it will be presented and analyzed. (shrink)

As scholars have shown, acceptance is key to the success of Payment for Ecosystem Services (PES) scheme. While many studies adopt a static cost-benefit perspective, few address the social process leading to acceptance. Drawing on Suchman (1995), this article examines the legitimacy process underlying the acceptance of a PES in agriculture. In particular, the role of collective action in the legitimisation process is analysed, using a combination of qualitative and quantitative methods of discourse analysis. Data from an agro-environmental PES (...) scheme in France on water quality shows that acceptance depends on the normative and cognitive legitimacy that actors confer upon a public policy. (shrink)

Volume 19, Issue 9, September 2019, Page 35-36.

One way to test vaccines is through human challenge trials in which participants are intentionally infected with a contagious organism to expedite the process of assessing the vaccine’s effectiveness. Some experts believe challenge trials may play an important role in fighting COVID-19, especially if the vaccines under current study do not demonstrate sufficient efficacy, if spread of COVID-19 is controlled to a point that radically slows down traditional trials, or if new vaccines need to be rapidly developed for specific subpopulations.1 (...) Challenge trials involve significant time, burden and risk, requiring participants to spend 3–6 weeks in legal quarantine for 24 hours a day in a high-security facility. During this time, no inperson visitors will be allowed, except for very limited inperson contact from researchers collecting necessary data and checks. Following the quarantine period, participants will be asked to attend numerous outpatient follow-up visits over the course of months, to further monitor their response to the vaccine. Participation involves being away from family who may themselves become sick during the global pandemic, as well as potential fear and mental anguish around being a ‘first’ subject. Because there is no definitive treatment for COVID-19, participants could experience serious illness. But even with milder illness, medical experts know very little about the long-term consequences of COVID-19 infection. This raises the question of how much people should be paid for their participation in COVID-19 challenge trials. Most think participants should be paid something, but many contend that we should be …. (shrink)

Background Payment of research participants helps to increase recruitment for research studies, but can pose ethical dilemmas. Research ethics committees (RECs) have a centrally important role in guiding this practice, but standardisation of the ethical approval process in Ireland is lacking. Aim Our aim was to examine REC policies, experiences and concerns with respect to the payment of participants in research projects in Ireland. Method Postal survey of all RECs in Ireland. Results Response rate was 62.5% (n=50). 80% (...) of RECs reported not to have any established policy on the payment of research subjects while 20% had refused ethics approval to studies because the investigators proposed to pay research participants. The most commonly cited concerns were the potential for inducement and undermining of voluntary consent. Conclusions There is considerable variability among RECs on the payment of research participants and a lack of clear consensus guidelines on the subject. The development of standardised guidelines on the payment of research subjects may enhance recruitment of research participants. (shrink)

Clinical investigators must engage in just subject recruitment and selection and avoid unduly influencing research participation. There may be tension between the practice of keeping payments to participants low to avoid undue influence and the requirements of justice when recruiting normal healthy volunteers for phase 1 drug studies. By intentionally keeping payments low to avoid unduly influenced participation, investigators, on the recommendation or insistence of institutional review boards, may be targeting or systematically recruiting healthy adult members of lower socio-economic groups (...) for participation in phase 1 studies. Investigators are at risk of routinely failing to fulfill the obligation of justice, which prohibits the systematic targeting and recruiting of subjects for reasons unrelated to the nature of the study. Insofar as we take seriously the obligation to engage in just subject recruitment and selection, I argue that we must acknowledge the implications low payments might have for subject recruitment and selection and examine the effect of low payments. If low payments de facto target the less well-off for phase 1 studies, we must defend the priority ranking of the obligation to avoid undue influence over the obligation of justice or adopt an alternative recruitment approach. This paper identifies a number of alternatives to the current system of low-value payments to research participants. (shrink)

This paper draws on ideas about policy innovation and adaptation to assess the extent to which ‘payments for ecosystem services’ can be seen as a challenge to traditionally more bureaucratic, state-centered ways of paying for the provisioning of environmental goods from agricultural landscapes through agri environmental policy. Focussing on recent experience in the United States and the UK, the paper documents the extent to which PES is now an established term of reference in AEP research and debate in both countries (...) and postulates that this may usher in a new discourse of environmental provisioning in agriculture. The PES landscape is, however, currently highly fragmented and largely experimental, with ‘PES-like’ approaches being piloted in the field through partnerships between state agencies and localized private and charitable interests. State-supported AEP programs remain substantially intact, and rather than any displacement of state action, there appears to be a more gradual insertion of PES approaches and metrics into standard AEP operating procedures. This institutional stickiness is partly due to the continuing difficulty of agreeing the metrics necessary for measuring outcomes but may also be due to the politically well defended nature of traditional AEP entitlements and associated policy networks. We conclude by suggesting a need for further research to better understand these specifically political constraints and sources of resistance to PES and the ambiguous consequences for institutions, policy networks, rural communities and environment. (shrink)

The paper by Lynch et al. argues that payments to research participants in biomedical research can be divided into three different categories, reimbursement, compensation, and incentive and...

Paying research participants in developing countries like Uganda raises ethical concerns over potential for undue inducement. This article, based on an exploratory study, reviewed 49 research protocols from a national HIV/AIDS research ethics committee database. Payments mainly adhered to the reimbursement and compensation payment models. Offers made were diverse but basic in order to limit undue inducement. Implications in terms of undue inducement and possible impact on participants and research are discussed. We end by recommending standardization across comparable studies (...) in the interests of promoting high-quality research, altruism, voluntariness, and restraining unfair reimbursement practices in research. (shrink)

Health reform debate understandably focuses on large system design. We should not omit attention to the “last mile” problem of physician payment theory. Achieving fundamental goals of integrative, patient-centered primary care depends on thoughtful financial support. This commentary describes the nature and importance of innovative primary care payment programs.

Bioethics, Volume 36, Issue 7, Page 757-764, September 2022.

Offering cash payments to research subjects is a common recruiting method but there is significant debate about whether and in what amount such payments are appropriate. This paper is concerned with exploitation and whether there should be a lower limit on the amount researchers can pay their subjects. When subjects participate in research as a way to make money, fairness requires that researchers pay them a fair wage. This call for the establishment of a lower limit meets resistance in two (...) places: (1) denial that the payments offered by researchers are wages for participation; and (2) concern about undue inducement. This paper critically examines these arguments for and against a lower limit. It shows that the need for a lower limit cannot be avoided by adopting a non-wage payment model and that concerns about undue inducement are unjustified in all trials except those that present greater than minimal risk. This analysis suggests the following compromise position: there should be an unconditional lower limit on payment amounts so that researchers cannot offer less than a fair wage, and when researchers cannot satisfy this limit because fairness requires a problematically large payment, then researchers should offer no payment at all. (shrink)

The practice of paying prisoners to for their participation in research has long been debated, and the controversy is reflected in the differing policies in the U.S. prison systems. Empirical study of financial payments to inmates who enroll in research has focused on whether this practice is coercive. In this study, we examined whether monetary incentives have the potential to be unduly influential among fifty HIV‐positive prisoners. The majority of prisoners surveyed believed that inmates should receive some compensation for their (...) involvement in research and disagreed with statements suggesting that the offer of payment constitutes undue influence. However, a sense of potentially being susceptible to undue influence was significantly higher among participants who had spent a longer time in prison and had less education. Overall, our findings suggest that most prisoners feel that they would be able to make a decision about research enrollment that is not solely based on an offer of monetary payment. (shrink)

This study examines the degree of state ownership on corporate bribery. Integrating the theories of state ownership and corporate corruption, we propose that state ownership influences bribery propensity and bribery intensity in different ways; it lowers a firm’s tendency to pay bribes but increases the relative amount of bribery payment. Building on the control rights/bargaining hypotheses, we demonstrate that state ownership shields firms from bribery demands by reducing administrative hurdles that include bureaucratic requirements of obtaining licenses or settling taxes (...) in business operations. However, state ownership elevates the level of bribes by weakening their capital mobility. Using a sample of 23,018 firms from 54 countries covering 2006 to 2013, we find evidence to support our hypotheses. This article contributes to corruption research by drawing attention to an important channel of corruption and by highlighting the importance of considering not only the propensity but also the intensity of bribe payments. (shrink)

It is widely thought that Robert Nozick’s views on rectification of past injustices are of critical importance to his theory of distributive justice, even perhaps justifying wholesale redistributive taxes in the present because of the undoubted injustices that have pervaded much past history. This essay undertakes to correct this impression—not mostly by disagreeing with Nozick’s claims, but nevertheless proceeding on basic libertarian theory. Of enormous importance is the role of putative innocents, who are defrauded by miscreants carefully covering their tracks (...) so that these recipients have no reason to think they are buying stolen property. But of equal importance is simply that the duty to rectify past injustices is not comparable to the original duty to respect property rights in the first place. (shrink)

To solve the current privacy leakage problems of cloud storage services, research on users’ payment intention for cloud storage services with privacy protection is extremely important for improving the sustainable development of cloud storage services. An evolutionary game model between cloud storage users and providers that considers privacy is constructed. Then, the model’s evolutionary stability strategies via solving the replication dynamic equations are analyzed. Finally, simulation experiments are carried out for verifying and demonstrating the influence of model parameters. The (...) results show that the evolutionary stable strategies are mainly affected by the privacy protection profit growth coefficient of both parties, input costs, free-riding gains, and other factors. If the profit growth coefficient is very small, users will not choose to pay and providers will not choose to actively protect user information. As the profit growth coefficient increases, both parties will promote the development of privacy protection with a higher probability. The results are beneficial for cloud storage providers to increase the number of paid users and thus to achieve the sustainable development of cloud storage service. (shrink)

This article considers the ethical implications of prospective payment from the perspective of physicians and other health care practitioners. It focuses on the argument that prospective payment creates ethical conflict by giving physicians an economic incentive to do less for their patients. This argument is criticized in two respects. First, available evidence is reviewed which suggests that the incentives actually created by different prospective payment schemes and their effect on "optimal" patterns of practice is uncertain. Further, it (...) is pointed out that ethical conflict originates in the dual role of physicians as agents and suppliers of service. Recognizing that such conflict exists under any payment mechanism, a better focus for the ethical evaluation of prospective payment is suggested that considers whether the incentive to do less is likely to have adverse effects on physician decisions, relative to decisions made under other payment mechanisms. Keywords: incentives, utilization, conflict of interest, efficiency, justice, agent CiteULike Connotea Del.icio.us What's this? (shrink)

There is strong opposition in bioethics to paying research subjects. This paper, building on earlier work, gives arguments on behalf of the permissibility of payment. It develops an analogy between payment to research subjects. And payment and regulation in the labour market Few seriously oppose payment in the labour market, and the reasons to allow payment carry over to payment to research subjects. The paper then considers and rejects an alleged disanalogy, that research is (...) special in that it involves subjects’ bodies. At greater length, it assesses the argument from the gift relationship: that the value of giving is good reason not to extend market norms into research. This argument has some force in pointing out the unattractiveness of some market motivations, but those who offer it usually overlook the coordination advantages of the market. Still, the gift relationshp argument against payment has something going for it, which is more than can be said for virtually all the other major anti-payment arguments. (shrink)

The aim of this paper is to evaluate the extent of the practice of using informal payments for accessing the services of public clinics or hospitals across Europe and to explain the prevalence of this corrupt practice using the framework of institutional theory. To achieve this, a multi-level mixed-effect logistic regression on 25,744 interviews undertaken in 2020 with patients across 27 European Union countries is conducted. The finding is that the practice of making informal payments remains a prevalent practice, although (...) there are large disparities in the usage of this practice in different European countries. However, informal payments by patients are more likely when there is a lower institutional trust and a higher degree of asymmetry between formal and informal institutions. The resultant proposal is that policy makers need to address the institutional environment to tackle such informal payments. How this can be achieved is outlined. (shrink)

Recent policy developments in the general area of disability have presented a whole range of ethical dilemmas for everyone involved in the development and delivery of services for disabled people at the national and local levels. This is almost certainly due to government acceptance of the principles of independent living and the social model of disability, and greater user involvement and control of support services, in particular ?direct payments?. This paper will centre on the ethical concerns that arise from recent (...) government policy regarding the latter. (shrink)

Should egg donors be paid? A negative answer might be offered on the ground that payment for egg donation is coercive. But is this viewpoint tenable? Is the offer of payment for egg donation really coercive? Even if not coercive, might payment for egg donation nonetheless be seen as exploitative? And if so why? The central argument of this paper focuses on the question whether the offer of payment for egg donation is an exploitative inducement and (...) therefore an undue inducement. Another question raised in this paper is whether, given that it is commodifying, payment for egg donation constitutes a failure to recognize the giftedness and true value of human life. (shrink)

If someone claims that individuals behave as if they violate the independence axiom when making decisions over simple lotteries, it is invariably on the basis of experiments and theories that must assume the IA through the use of the random lottery incentive mechanism. We refer to someone who holds this view as a Bipolar Behaviorist, exhibiting pessimism about the axiom when it comes to characterizing how individuals directly evaluate two lotteries in a binary choice task, but optimism about the axiom (...) when it comes to characterizing how individuals evaluate multiple lotteries that make up the incentive structure for a multiple-task experiment. We reject the hypothesis about subject behavior underlying this stance: we find that preferences estimated with a model that assumes violations of the IA are significantly affected when one elicits choices with procedures that require the independence assumption, as compared to choices elicited with procedures that do not require the assumption. The upshot is that one cannot consistently estimate popular models that relax the IA using data from experiments that assume the validity of the RLIM. (shrink)

Modern payment cards encompass a bewildering array of consumer technologies, from credit and debit cards to stored-value and loyalty cards. But what unites all of these financial media is their connection to recordkeeping systems. Each swipe sends data hurtling through invisible infrastructures to verify accounts, record purchase details, exchange funds, and update balances. With payment cards, banks and merchants have been able to amass vast archives of transactional data. This information is a valuable asset in itself. It can (...) be used for in-house data analytics programs or sold as marketing intelligence to third parties. This research examines the development of payment cards in the United States from the late 19th century to present, drawing attention to their fundamental relationship to identification, recordkeeping, and data mining. The history of payment cards, I argue, is not just a history of financial innovation and computing; it is also a history of Big Data and consumer surveillance. This history, moreover, provides insight into the growth of transactional data and the datafication of money in the digital economy. (shrink)

Individuals and businesses make numerous payments every day. They sometimes have choices about what forms of payment to make or accept, and at other times are effectively forced to use a particular form. Often there is an asymmetric power relationship between payer and payee that raises the issue of whether one side unfairly exploits the other. Is it unethical exploitation for an employer to pay employees with a fee-laden payroll card over other more convenient forms of payment? Does (...) the fee structure of payment networks such as Visa and MasterCard unfairly exploit merchants? The bitcoin payment system is an ethical as well as technological evolution as it was designed to be an electronic payment system that does not rely upon trust. Can an entire payment system like bitcoin be “evil,” as charged by Krugman? Payment tools as such are ethically neutral, but can be used in an ethical or unethical manner. (shrink)

Poor people predominate as a subgroup of those who take part in healthy volunteer research. They are subjected to minimised but unknown risks and unpleasant burdens so that the safety of new medicines can be evaluated. This is prima facie unfair especially given that the poor are often unable to access expensive medicines. Although participants in this kind of research often do receive compensation for their time, these payments are usually capped at a very low level. This paper defends a (...) version of a reimbursement model for the payment of research subjects. This model is practical, would benefit those without an income who take part in research, and would make it possible for those in regular work to take part in phase 1 research. (shrink)

Human Infection Studies have emerged as an important research approach with the potential to fast track the global development of vaccines and treatments for infectious diseases, including in low resource settings. Given the high level of burdens involved in many HIS, particularly prolonged residency and biological sampling requirements, it can be challenging to identify levels of study payments that provide adequate compensation but avoid ‘undue’ levels of inducement to participate. Through this embedded ethics study, involving 97 healthy volunteers and other (...) research stakeholders in a malaria HIS programme in Kenya, and using in-depth interviews, focus group discussions and observations during and after a malaria HIS, we give a grounded account of ethical issues emerging in relation to study payments in this setting. While careful community, national, international scientific and ethics review processes meant that risks of serious harm were highly unlikely, the levels of motivation to join HIS seen could raise concerns about study payments being too high. Particular value was placed on the reliability, rather than level, of study payment in this setting, where subsistence livelihoods are common. Study volunteers were generally clear about the study aims at the point of recruitment, and this knowledge was retained over a year later, although most reported experiencing more burdens than anticipated at enrolment. Strict study screening procedures, regular clinical and laboratory monitoring of volunteers, with prompt treatment with antimalarial at predetermined endpoints suggested that the risks of serious harm were highly unlikely. Ethical concerns emerged in relation to volunteers’ attempts to conceal symptoms, hoping to prolong residency periods and increase study payments; and volunteers making decisions that compromised important family relationships and personal values. Our findings support an interpretation that, although study volunteers were keen to join the study to access cash payments, they also paid attention to other features of the study and the general clinical research landscape, including levels of risk associated with study participation. Overall, our analysis shows that the ethical concerns emerging from the study payments can be addressed through practical measures, hinged on reducing burdens and strengthening communication, raising important issues for research policy and planning. (shrink)

Grimwade et al highlight the current lack of a universal, standardised approach to the payment of participants taking part in controlled human infection model studies.1 As they discuss, payment for these studies is controversial, with many voicing arguments for and against higher payments, particularly for those studies which involve significant burdens to the participant. The main concerns about overpayment relate to the concepts of undue inducement or coercion, whereas underpayment raises concern about exploitation and unfair treatment. In many (...) healthy volunteer trials compensation for travel, time and inconvenience are generally accepted as fair payment, but payment for risk is less accepted, with a belief that non-therapeutic studies should only incur minimal risks, so payment for risk should not be necessary.2 This paper argues that payment for risk should be included for CHIM studies. Their findings among members of the UK public and CHIM experts from a variety of centres suggest that there is support for greater risks being associated with higher payments for participants. The amount of compensation offered by a trial has to be approved by an ethics committee/institutional review board, and some research suggests that IRB members have concerns about higher payments being offered, with only approximately one-third agreeing that payment should be offered for risk.3 Without agreement and clear guidance for calculating compensation for these types of trial, there is bound to be …. (shrink)

To prepare for potential human infection challenge studies involving SARS-CoV-2, we convened a multidisciplinary working group to address ethical questions regarding whether and how much SAR...