Lila volunteered for a research study on anorexia despite risks of discomfort and infection. This raised an ethical conflict between those who thought Lila's illness made her unable to properly consent (Nurse Miller) and those who thought she could participate to further research (Dr. O'Connor). In my role as Lila, I argued her participation aligned with Kant's view that individuals have a right to pursue happiness for the greater good. However, others critiqued that Lila's self-interest and the researchers' goals were not truly moral under Kantian ethics. The conclusion was Lila should not participate until fully competent to avoid using her merely as a means to an end.

1. Can a Research Subject Be Too Eager to Consent?
Sarah Orr
Dr. Lorraine Arangno
Introduction to Ethics 1020-002
May 12 2016

2. Can a Research Subject Be Too Eager to Consent?
Table of Contents
I. Summary of the Case Study: “Can A Research Subject Be Too Eager to
Consent?”
II. Statement of the Central Ethical Conflict
III. Statement of the Role and Philosophical Position
IV. The Principles of Faux Kantian Ethics
A. The Concept of Motivation
B. The Definition of Duty
C. Subjective Principles
D. Material Maxims
E. Hypothetical Imperative
F. Imperatives of Skill
G. Imperatives of Prudence
H. Objective Principles
I. Formal Maxims
J. The Categorical Imperative
V. Critique of Faux Kant’s Ethical Position
VI. Response to this Criticism
VII. Conclusion

3. Summary of the Case Study: “Can a Research Subject Be Too Eager to
Consent?”
A twenty-one year old adult named Lila Goldberg was admitted into a hospital for
her anorexia and mental illness. She readily volunteered to participate in a research
study that would measure her conditions. She had signed a consent form approved by
the Institutional Review Board (IRB). The IRB were in charge of the procedures of the
project and they approved the consent form. However, the spinal procedures that she
would go though, would likely cause discomfort and infection.
Statement of the Central Ethical Conflict
The major ethical conflict was between Dr. O’Connor and Nurse Sharon Miller.
Nurse Miller thought that Lila’s illness was causing her to think irrationally. From Miller’s
perspective, anorexia patients were willing to harm themselves. Nurse Miller believed
that due to Lila’s mental condition, she should not participate in the study, as she was
concerned for Lila’s safety. From Dr. O’Connor’s perspective, Lila was competent
enough to participate in the case study. Having her in the study would potentially help
the researchers discover neurophysiological abnormalities in anorexia. Dr. O’ Conner
thought that Lila would be a good candidate for the project and wanted her to volunteer.
Unlike Lila and Dr. O’Connor, Nurse Millar and the IRB did not think that allowing Lila to
participate would be the best idea.
Statement of the Role and Philosophical Position

4. In regards to the case study presentation, I portrayed the role of Lila Goldberg.
Lila wanted to participate in the case study and was willing to go through the procedure,
even if it causes her discomfort and possibly harm. Philosopher Immanuel Kant states
that every rational being has a natural right. Based on what Kant states, Lila has a
natural right to pursue her happiness because it is beneficial for the greater good.
The Principles of Faux Kantian Ethics
In order for one to understand why Kant would agree with my position, one needs
to understand Kant’s ethical position in some detail. Immanuel Kant was a metaphysical
moralist. One of the goals of metaphysical moralists is to categorize duties and values.
Questions that were asked were “What is duty?” and “What ought I do to?” Kant was
concerned with determining what makes an act right or wrong. From Kant’s Concept of
Motivation, people are motivated by reason alone and ought to do the right thing
because it is right.
In Groundwork for the Metaphysics of Morals, Kant states “Duty is the necessity
to act out of reverence to the moral law.” “Necessity” refers to a requirement and
“reverence” is a deep respect for the law. The moral law describes respect for the rights
of all human beings unless they threaten to harm one another. Author Robert Johnson
states “In Kant’s terms, a good will is a will whose decisions are wholly determined by
moral demands…the Moral Law” (2004). Kant states “Good will is that will which is
motivated to act for the moral law, discovered inside of us.” Kant says “Two things fill
me, the starry heavens above me and the moral law within me.” There are different
ways to determine whether an action is right or wrong.

5. Kant states that “Objective principles are true for all rational agents.” The two
kinds of objective principles are the Hypothetical Imperative and Categorical Imperative.
According to Kant, the Subjective Principles are propositions that guide behavior. A
maxim is a principle, upon which a person wills to act. Material Maxims are formulated
as conditional statements. They explain cause and effect, “if X, then Y.” These maxims
are then tested by the Hypothetical Imperative, which refers to logical cause and effect.
According to Robert Johnson “A hypothetical imperative is a command that also applies
to us in virtue of our having a rational will” and it requires us to “exercise our wills in a
certain way” (2004). The Hypothetical Imperative states that any rational agent who
desires some end, must necessarily will the means to that end” (Arangno, 2016). For
Lila, she must act upon her will to be a part of the project by participating in the project
and talking to Dr. O’Connor and Nurse Millar. Conditional statements, also called
material maxims are tested against the Hypothetical Imperative. In other words, Lila’s
desire, inclination, or self-interest to participate are tested against an endless cycle of
cause and effect: If X, then Y, if Y, then Z and so on. The self-interests of Lila, Nurse
Millar, Dr. O’Connor and the IRB must be tested by the hypothetical imperative to be
use that they are reasonable.
The two types of Hypothetical Imperatives are Imperatives of Skill and
Imperatives of Prudence. Imperatives of Skill “express a means for obtaining a desired
goal” and Imperatives of Prudence are “general rules for obtaining happiness” (Kant’s
Ethics, n.d). Kant says that a moral person is a happy person but moral duty is separate
from happiness. People must pursue happiness at the right time and right place. In this
case, Lila wants to pursue her happiness by participating in the project. However, she

6. signed the papers that Dr. O Connor gave her. As a result of signing the papers, Lila is
also doing it for the research as a moral duty. However, there are other concepts that
needs to be addressed.
Formal Maxims are formulated declarative statements: “Do/Don’t do X.” Take
action or do not take action under no conditions. These maxims are then tested by the
Categorical Imperative, which determines a person’s will to act. Robert Johnson quotes
Kant and states that the Categorical Imperative describes duty to the moral law and
“commands us to exercise our wills in a particular way, not to perform some action or
other” (Johnson, 2004). The Categorical Imperative is the ultimate test for formal
maxims. The formal maxims are declarative statements of what a person ought to be
doing. In this case, the decision to allow Lila to participate would be tested against the
four formulas of the Categorical Imperative.
First, the Principle of the Law of Nature or Universalizability says to take action
only if it can be beneficial to all rational agents. The Principle of Universalizability says
universalize one’s formal maxim. It is saying “If I can do X, than everyone ought to do
X.” Second, the Principle of Ends values the respect of persons. It states that humans
are Ends to themselves, and are not to be used as means to ends. Third, the Principle
of Autonomy says, be a friend to yourself, discover your talents and pursue intellectual
virtues, moral virtues and creativity. There is a struggle between what one wants to do
and what one ought to do. Next, the Kingdom of Ends Formula is defined as a
“systematic union of different rational beings under common laws” (Johnson, 2004).
Kant says that the aim of this formula is for people to act on “principles which could earn
acceptance by a community of fully rational agents each of whom have an equal share

7. in legislating these principles for their community” (Robert Johnson, 2004). Finally, the
Formula of End Itself says an action is moral if one does not use it as a means to an
end for one’s own benefit. This leads to a debate on whether Lila should be allowed to
participate and whether her motivation is reasonable.
Critique of Faux Kant’s Ethical Position
What may be good for the majority may cause harm or a feeling of rejection to
the minority. In this case, while the case study would likely provide information for a
possible cure, it is not the right thing to do if it puts Lila’s life in danger. Sharon Miller
says that Lila wants to participate and she is being influenced by her illness. Another
philosopher, Hillel said “If I am not for myself, then who shall be for me? But if I am for
myself alone, then what am I?” In Lila’s case, if she is not for herself, no one else would
be. However, since she only has her interests in mind, then she is not living up to her
potential Kant states “In order for an act to be moral, it must be done for the sake of
duty and never out of a sense of inclination, desire, or self-interest.” Dr. Connor’s goal is
to discover abnormalities in anorexia that could not only help people in need, but also
support his job and reputation. Dr. Connor only wants Lila to volunteer out of his self-
interest. Therefore, to keep her safe, Lila should not be able to participate in the case
study.
Response to this Criticism
From Dr. O’Connor’s position, Lila wanted to volunteer for the case study and
she was competent enough to do so. Having her in the study would be a great
opportunity for the researchers and doctors to discover any abnormalities in anorexia.

8. That information could lead to a cure for the illness in the future. Doing this case study
would be a benefit for the greater good of society. As Kant stated “All human beings
have the right to pursue happiness” (Arangno, 2016) and this includes Lila. Allowing Lila
to participate would be beneficial to the greater good by providing results from her case
study that could reveal future treatments for anorexia. Even though, the procedure
might harm her, it is still her right.
Conclusion
In conclusion, the story of Lila Goldberg will continue to cause debate in medical
ethics. The ethical solution would be to hold off on the project until Lila is fully
competent enough. Lila should get extra support from her family and hospital
advocates. Although Lila read the forms that Dr. O’Connor gave her, she was too eager
to participate and did not thoroughly read them. Nurse Miller should help Lila view
herself as valuable, and also respecting her choice. Dr. Connor should not view Lila
only as a means to his end goal of finding a cure, even though it is for the greater good.
In the roleplay, Millar told Dr. O’ Connor that Lila was not a statistic, but a human being.
Finally, the IRB should carefully analyze the approval forms and make sure that the
risks are known. The moral dignity of the patient outweighs the probability of a research
project.

9. Works Cited
Author unknown. “The Categorical Imperative.” The Internet Encyclopedia of Philosophy. 2001.
Web. Retrieved March 31 2016 from http://www3.nd.edu/~rbarger/categorical-imperative.html
Author unknown. (n.d). “Kant’s Ethics.” Retrieved April 30 2016 from
http://users.wfu.edu/hhardgra/kanteth.html
Arangno, Lorraine. (2016, March-April). “Kant Principles.” University of Colorado, Colorado
Springs. April 2016. Lecture.
Hastings Center Journal of Biomedical Ethics: Can A Research Subject Be Too Eager to
Consent?
Hauptli, Bruce W. “Lecture Supplement on Kant’s Foundations for the Metaphysics of Morals.”
2013. Web. Retrieved March 31 2016
fromhttp://www2.fiu.edu/~hauptli/KantsMetaphysicofMoralsLectureSupplement.htm
Johnson, Oliver A. Reath, Andrews. “Ethics: selections from classical and contemporary
writers.” (11th ed.) Cengage Learning. Library of Congress. Boston, MA. 2012, 2007, 2004.
Print.
Johnson, Robert, (2004, February 23). “Kant’s Moral Philosophy”, The Stanford Encyclopedia of
Philosophy (Summer 2014 Edition), Edward N. Zalta (ed.), Retrieved April 29 2016 from
http://plato.stanford.edu/entries/kant-moral/
Kant, Immanuel. “Foundations of the Metaphysics of Morals.” Ethics: Selections from Classical
and Contemporary Writers. Eds. Johnson, Oliver A., and Andrews Reath. Boston: Wadsworth,
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