Sacha Baron Cohen’s “Bruno” and the Erosion of Informed Consent
Bear with me. I promise this isn’t a movie review. There are no plot spoilers below. This really is about research ethics — in particular, the ethics of informed consent.
But it starts out what seems like worlds away, in the world of cinema. Check out this article, from Forbes, about a high-profile movie currently in theatres: Bruno’s Legal Precipice
Experts say Sacha Baron Cohen’s latest mockumentary has pushed business ethics over the edge.
Baron Cohen and his film’s distributor, Universal Pictures, have meanwhile been impervious to a flood of lawsuits that have emerged from angry individuals who appeared in the film thanks to a team of legal heavyweights, a carefully constructed legal framework and a rule that all people who appeared in the film sign consent forms.
But legal experts not involved the case are still concerned about the ethics of Bruno’s tactics….
Now, a film is not a Randomized Controlled Trial, and consenting to be shown on-screen is not the same as consenting to have something injected into your veins. But still, those of us interested in research ethics should be interested in this story, and not just because there’s a sense in which Baron Cohen’s movies (both Bruno and Borat) are highly-publicized “experiments”, designed to determine how people will react in a range of socially-awkward scenarios.
Three points:
1) This story is a good reminder of why, in Research Ethics (and in Clinical Ethics) we repeat over and over again the mantra: “Consent…is…not…a…form. Consent…is…a…process.” The goal of well-intentioned consent-seeking is not legal reassurance, but actual consent — we want the individual receiving treatment or participating in research really to understand and agree to what they’re getting into. The makers of Bruno only cared about legal coverage. Researchers presumably want to hold themselves to a higher standard.
2) Let’s grant that consenting to be in a movie is very different, in many ways, from consenting to participate in research. Still, there might well be reason for those of us interested in Research Ethics to worry about the shenanigans required to make this movie. Because arguably what this kind of film-making does is erode standards regarding, and public confidence in, the very notion of informed consent.
3) If you think consenting to be in a movie really is quite different from consenting to participate in an RCT, it’s worth thinking about just why it’s so different. Does the difference lie in the goal? Movies are entertainment; research is an attempt to contribute to our shared body of knowledge. Well, the social benefit of research might arguably imply a more relaxed standard for consent, not a higher one. Is it the history of the 2 enterprises? Modern standards for Research Ethics grew in part out of a reaction against unethical research of the past. The film industry doesn’t have (as far as I can think) its own version of Nazi human experimentation or the Tuskegee syphilis study. Or is the difference a matter of institutional setting? Research (at least the kind regulated by institutional ethics review) is, well, institutional. It’s typically done by people at large, well-funded organizations, ones with avowed obligations to promote the public good. Or is the difference something else entirely?
Sometimes we really can learn a lot from movies; just not necessarily by seeing them.
Research Ethics Blog 
Perhaps this sort of thing is long overdue. In the film and television industry, I think many people have developed a fundamental misunderstanding of what “informed” consent means.
With the explosion of reality television and social media, people throw their image (and therefore rights) around willy nilly, expecting five minutes of fame, and it’ll all work out fine. It often doesn’t. Perhaps a high-profile, deliberate, humiliating burn of these people will give folks pause, which might in fact be a good thing.
I suspect it won’t really be such a watershed – it could be the opposite, just a one-upmanship of an already hideous process. But you never know.
I agree that informed consent is not a form, but a process. My consent initiative start up tries to document that process in a way that is relevent to both doctor and patient. You may see something in this that will be of value to the research ethics community http://www.consentcare.com
If you are looking for the film industry’s dark past, try Triumph of the Will.
The idea missing from your post is that of critical inquiry. When Cohen films a bar full of people singing “Throw the Jew Down the Well,” he’s not aiming for medical beneficence; he’s trying to expose latent anti-Semites. The TCPS recognizes this distinction, but ethics committees still struggle with it.
A good intro to Cohen’s goals is his interview with NPR’s Fresh Air.
New article on informed consent on NYTimes Health … http://www.nytimes.com/2009/07/30/health/30chen.html?ref=health