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Critics Question Ethics of Using Unknowing Welfare Recipients in Study

February 12, 1990

DALLAS (AP) _ Experts in ethics are questioning a federal experiment that denies supplemental aid to some indigent people in Texas and four other states to determine how well they can live without it.

Extra Medicaid and child-care benefits now go to about 8,000 people in Texas to encourage them to keep new jobs, while about 800 people - selected at random by birth date - are excluded as a control or comparison group.

On April 1, those extra benefits will be available to more than 50,000 people statewide - but not to the 800 unlucky Texans who face two more years without the extra help, The Dallas Morning News reported Sunday.

The study aims to see how well the new expanded programs wean people off the welfare rolls.

Similar experiments are being conducted in Ohio, Washington state, New York and Wisconsin, federal officials told the newspaper last week.

Though federal officials say denying the additional benefits to small, so- called control groups is vital to determine whether the new programs work, critics disagree.

″People ought not to be treated like things, even if what you get is good information,″ said Philip Broyle, associate director for medical ethics of the Hastings Center, a New York think tank concerned with the ethics of experiments on people.

Broyle said the study violates the kinds of federal standards medical experiments must meet. Those standards include informed consent - that anyone in an experiment must be aware of it and of all its consequences. And they must have the option to refuse participation.

Neither informed consent nor the right of refusal was offered to participants in the welfare study, officials said.

The pilot program rewards welfare recipients who find jobs or job training. Traditionally, such recipients have received four months of free medical care, plus some child care, after they leave the welfare rolls. The experimental program extended the benefits to one year of Medicaid coverage and subsidized child care - to all but the 800.

The theory is that the extended benefits will encourage people to take and stay with entry-level jobs that are unlikely to offer medical insurance or child care immediately. And the tax money saved by getting those people off welfare will more than balance the cost of the new program.

State officials said last week that they would try to break their contract with the federal government and provide the benefits to the 800.

″We’re planning to argue with them,″ said Claudia Langguth, deputy commissioner for the client self-support division of the Texas Department of Human Services.

In 1988, Congress decreed that people receiving benefits from Aid to Families with Dependent Children and Medicaid and who get a job or job training would be eligible for the extended benefits beginning April 1, 1990.

Texas officials decided they wanted to try offering the new benefits a year early on a small scale.

They got federal money for pilot programs in five urban areas but were required to exclude about 10 percent of those eligible - the control or comparison group - to see if they stay off welfare without the extra benefits.

Federal officials say they were aware of the ethical question involved in the experiment.

″That issue was recognized and considered in the review of the Texas proposal,″ said Sidney Trieger, director of the federal division of health systems and special studies of the Health Care Financing Administration. He is in charge of evaluating the experimental results.

″It was worth proceeding,″ he said.

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