Participation With Compensation: Ethical Considerations for Research Payment Practices With People Who Are Incarcerated

Abstract

The participation of incarcerated individuals in research is necessary to appropriately address the health disparities that affect them and to adapt and implement health services for the carceral setting. Incarceration significantly impacts health, leading to negative outcomes including accelerated aging and increased mortality, with these effects disproportionately impacting communities of color. The U.S. Department of Health and Human Services’ Office for Human Research Protections outlines ethical approaches to compensating individuals who participate in research activities, yet lacks specific guidance for payment within carceral settings. Historical abuses in carceral research underscore the persistent need for robust protections for incarcerated research participants. Existing regulations offer some protection but inadequately address ethical payment practices. Substantial variability in payment policies across carceral systems and vague national guidelines pose ethical challenges in ensuring equitable treatment for incarcerated research participants. We outline the ethical concerns related to compensating incarcerated individuals for participating in research and present a framework of approaches to payment. We argue for payment parity between incarcerated and community research participants. More community-engaged research is needed to understand the perspectives of incarcerated individuals on ethical payment.

The Need for Research in Carceral Settings

To improve the public health of our communities and address health equity, we must improve health care in jails and prisons. Incarceration has been linked to negative health outcomes, including accelerated aging, decreased life expectancy, and increased risks for chronic illness (Massoglia & Pridemore, 2015; Puglisi & Wang, 2021). Incarceration is effectively a structural determinant of health. Incarceration disproportionately affects communities of color, exacerbating health inequities (Wang & Shavit, 2023). Yet, incarcerated individuals are often excluded from public health and clinic research activities. Complete data on Black men are missing from clinical trials and epidemiological datasets. This hinders our understanding of health disparities (Hinton & Cook, 2021; Wang et al., 2014).

There are appropriate limitations to conducting research in carceral settings, given the long and troubling history of abuse and coercion of incarcerated people to participate in research (Glenn, 2016; Hornblum, 2013; Reiter, 2009). The U.S. Department of Health and Human Services (HHS) has established regulations to safeguard incarcerated research participants: 45 CFR 46, subpart C. These regulations state that research should be of minimal harm and risk, not of greater risk than a community-based participant would accept, and have potential to improve the well-being of the participant. Research also must focus on conditions that disproportionately affect incarcerated populations and must be reviewed by an institutional review board (IRB) that has a “prisoner representative,” someone who has knowledge of the prison context (Institute of Medicine, 2007).

Current Payment Guidelines

Forty-five CFR 46, subpart C, although vital, lacks the specificity that researchers need to guide some practical ethical decisions in this unique context. As an example, limited guidance exists on appropriate payment for incarcerated participants. The HHS Office for Human Research Protections (OHRP) states that for research involving incarcerated individuals, advantages given to the individual must not be “of such a magnitude that his or her ability to weigh the risks of the research against the value of such advantages in the limited choice environment of the correctional institution is impaired” (Institute of Medicine, 2007). This guidance provides no details on the amounts or forms of payment that are permissible, leaving researchers to decide whether incarcerated individuals should be compensated for participation in studies and if so, how much.

In a 2009 study describing policies on compensating incarcerated research participants in state prisons across the United States, researchers found wide variability in policies. State prisons in Alaska and Iowa prohibited incarcerated individuals from being compensated for research, whereas state prisons in California and Colorado allowed payment to only contribute to the individual’s canteen how balance (account for personal use while incarcerated; Smoyer et al., 2009). No published data show payment has evolved in state prisons across the United States since the release of this study, and there is no published research documenting payment policies in jails.

Federal guidance for research in community settings indicates that payment is an ethical practice, with OHRP stating that “[p]aying research subjects in exchange for their participation is a common and, in general, acceptable practice” and “[r]emuneration for participation in research should be just and fair” (HHS, n.d.). The policies give IRBs discretion to determine appropriate payment amounts, benchmarking them off of local wages and costs (OHRP, 2019). There is no such guidance on research in carceral settings.

Notably, monetary or nonmonetary compensation are not the only ways that a study conducted in a carceral setting can be coercive. Individuals can be pressured to participate by other incarcerated people or staff. Moreover, given the restricted liberty of incarcerated individuals, experiencing something new or a break from the monotony of incarceration could be factors unrelated to compensation that contribute to the potential for coercion. Here, we focus specifically on compensation.

Potential Payment Models in Carceral Institutions

We discuss several potential approaches to research payment (Table 1) and conclude by asserting that payment aligned with community standards is both the most ethical and the most practical approach in most cases. Here, we focus particularly on minimal risk studies and more-than-minimal risk studies on implementation of evidence-based pharmacologic or nonpharmacologic interventions.

Table 1.

Framework of Different Payment Strategies

Strategies	Pros	Cons
No research payment	Avoids undue influence and coercion	Exacerbates disparities; devalues the incarcerated voice; decreases participation
Based on wages	Less risk of undue influence	Devaluing of an individual’s contributions; exploitation of participation; unjust carceral wages
Based on purchasing power	Equity; acknowledges porous economy and cost of goods in carceral facilities	Concern for undue influence still possible if compared with prison wages as sole income source; difficult to accurately determine and very variable
Alignment with community standards	Equality; acknowledges low purchasing power; ethical; practical	Concern for undue influence is possible if compared with prison wages as sole income source

Banning Research Payment in Carceral Institutions

One proposed model is to implement a ban on research participant compensation in correctional settings. This approach aims to eliminate the potential for undue influence and coercion by ensuring that no financial incentives are offered to incarcerated individuals. However, this model raises important concerns.

Most importantly, such a ban would exacerbate existing inequities between incarcerated and nonincarcerated populations. Research participants in community settings are routinely compensated for their time and effort, recognizing their contributions and the inconvenience of participation. To not offer compensation to incarcerated patients perpetuates unjust practices of uncompensated participation as well as devalues the knowledge and expertise of people experiencing incarceration. More pragmatically, compensation can increase diverse participation rates in an ethically acceptable way (Hanson et al., 2012), helping to address the concerns about the lack of inclusion of incarcerated people in important public health research.

Basing Compensation on Carceral Wages

Another model is to pay incarcerated individuals a calculated equivalent of payment to community members but adjust by hourly wage (e.g., based on “average working wage”). In Louisiana carceral facilities, hourly wages can be as low as $0.04 per hour. Other state prisons may not give wages for jobs worked inside prison (Sawyer, 2017). If researchers offer $25 per hour to incarcerated research participants in Louisiana, a participant may feel an undue influence to participate, since this would be between 25 and 625 times their hourly wage. Even with informed consent, a participant may be willing to take on greater risks than those in a community-based setting for the same payment because of their low wages—an undue influence. This perspective, however, ignores that the extremely low wages incarcerated individuals receive are, themselves, arguably unethical, making them a poor basis off of which to make decisions about ethical research payment (American Civil Liberties Union, 2022).

Furthermore, carceral facilities are economically porous. Carceral employment income is often not the only source of money that incarcerated people have. A friend in the community could deposit $25 into a commissary account, a mother could share her wages with an incarcerated son, or an incarcerated individual could access assets obtained prior to incarceration.

One study showed that the average amount spent per person in prison commissaries each year is higher than the average amount that an incarcerated individual makes in a year (Raher, 2018). In Massachusetts, for instance, incarcerated individuals spend nearly $96 a year on hygiene products and $940 on food and beverages (Raher, 2018). It would take approximately 7,400 hours (more than three times the number of standard working hours in a year) to earn enough to buy these necessities at a wage rate of $0.14 per hour, the lower end of wages an incarcerated individual earns in Massachusetts. As people who are incarcerated have access to money outside of their very low wages, there is likely less undue influence from research payments that well exceed hourly wages.

Basing Compensation on Purchasing Power

Another option is to base research payment on purchasing power (i.e., “purchasing parity ratio” benchmark). That is, how much does $25 purchase in the community compared with the prison setting? Many commissary items in a prison are more expensive than in a retail store (Raher, 2018; Sawyer, 2017), making the purchasing power of incarcerated individuals lower than in many community settings. This would suggest paying people who are incarcerated more than community members.

However, incarcerated people and community members have such different day-to-day expenses that complicate this comparison. Community members pay rent or mortgage, buy car insurance or pay to use public transportation, and purchase their own food—incarcerated people cannot do these things. Incarcerated individuals may have legal fees, restitution debts, and loss of community income due to incarceration or a record of convictions. Thus, it becomes difficult to draw comparisons in a meaningful way because the economies of “purchasing power” differ.

Basing Compensation on a Community-Equivalent Payment

Alternatively, incarcerated individuals could be given the same payment as a community-based participant would for participation in the same type of research. A payment rate aligned with community practice would prevent exploitation due to underpayment and promote equity (Christopher et al., 2017). Payment parity would mean applying HHS guidance with regard to payment in both community and carceral settings. The HHS Secretary’s Advisory Committee on Human Research Protections asserts that compensation for time, effort, or the appreciation of participants is not generally considered undue influence, as it acknowledges inconvenience and the opportunity cost of forgoing of other activities. Indeed, payment may partially incentivize participation, which is ethically acceptable, but should not cause undue influence (Hanson et al., 2012).

A community-equivalent payment ensures compensation occurs, does not perpetuate exploitative labor practices, and aligns with the porous nature of carceral economies. A community-equivalent rate can be assessed using a similar approach for ethical compensation practices among vulnerable populations in the community to avoid undue influence. In fact, researchers have argued that paying low-income people fairly (for instance, $50/hour, far above minimum wage) is equitable and helps them surmount obstacles to participating in research, despite the fact that higher payments may have greater influence on them than a higher-income person (Britez Ferrante et al., 2024).

A community rate may be higher than most carceral research practices. If a community rate is not used, researchers then need to decide by how much they would reduce a community rate for a carceral setting, as there is no standard discounting rate. Given the porous and variable nature of the carceral economy, any reduction would be, at least to some extent, arbitrary.

Some evidence suggests high compensation payments increase both the willingness to participate and the perceived risk of the study, leading potential participants to spend more time reviewing risk information (Cryder et al., 2010). Community-aligned compensation is ethical only if it exists within thoughtful, ethically designed research in this setting, including robust informed consent, ensuring payments go to the intended participants, implementing appropriate monitoring and oversight of research studies, and providing support to carceral institutions and relevant IRBs to manage and support research.

Researchers and IRBs can find ways to strike a balance between undercompensating incarcerated people and providing so much payment that they might be coerced to participate. We believe that compensating incarcerated research participants at a rate aligned with community standards would strike this appropriate balance, particularly given the problems identified without alternatives for payment. Failing to compensate incarcerated individuals to avoid undue influence, while simultaneously continuing research, may only further devalue incarcerated people, echoing their historical exploitation within research.

Additional Considerations: Study Risk

One additional key issue is the level of risk a study entails. Concerns about undue influence or coercion increase significantly with greater-than-minimal risk studies (e.g., studies such as clinical trial involving pharmaceutical agents or medical devices). The level and type of risk associated with any given study must be carefully considered alongside compensation plans.

Higher risk necessitates closer monitoring throughout the study. Beyond initially agreeing to a study, an incarcerated research participant may be less likely to report adverse events or risks that occur during the study due to a fear of losing out on the potential compensation (Hornblum, 2013). Greater-than-minimal risk studies conducted in carceral settings require rigorous monitoring and support systems to ensure participants can report adverse events without fear of losing compensation, even if they discontinue the study drug or intervention.

Certainly, there are some studies (e.g., drug safety trials) that are high risk and do not benefit participants or the incarcerated community. These fail other tests of research bioethics of beneficence and justice and federal protections put in place (i.e., these studies should likely not be conducted in prisons, given the vulnerable population). Yet, as we argue, it remains crucial to include incarcerated individuals in research to advance health equity, particularly research, such as health services or implementation science research, that focuses on the unique challenges of the carceral health setting.

With higher risk studies, ethical challenges must be meticulously managed. Strategies such as robust informed consent processes, continuous monitoring, and clear avenues for reporting adverse events without financial penalty are essential to mitigate these risks. The most ethical approach is not to avoid compensating incarcerated participants but to ensure that the study’s design and oversight adequately address the unique risks and vulnerabilities involved.

If those safeguards cannot sufficiently mitigate risk, there may be circumstances in which, for higher risk studies, compensation that is commensurate with community compensation would result in high risk of coercion, and alternative compensation practices would have to be considered. In those cases, investigators should also consider whether it is necessary and appropriate to conduct this research in a carceral setting.

Next Steps

A lack of clear guidance on payment for people who are incarcerated could facilitate unethical research payment and introduce barriers to the conduct of research in carceral settings. We recommend that carceral systems, accreditation bodies, and other relevant professional societies establish policies and guidelines for payments to incarcerated individuals that align with community standards for minimal risk studies. The lack of specificity in current guidance places an additional burden on researchers trying to work in this setting, who must develop their own approaches to payment and navigate the distinct policies of each prison or jail system. Community-equivalent payment should be the default, not the exception.

To do this we recommend the following:

• •Updated policies from the OHRP that offer greater specificity on ethical payment practices in carceral settings. These national guidelines should clearly specify that researchers should pay incarcerated research participants if they would pay community-based participants and recommend parity in payment practices between populations regardless of their incarceration status.
• •Updated local policies in prisons and jails to allow for the appropriate payment of participants. Any bans on payment should be replaced by policies that aim to attain parity between prison and community settings. Policies regarding payment to incarcerated research participants should clearly distinguish between minimal risk and greater-than-minimal risk studies. Minimal risk studies may justify fair compensation to enhance participation, while greater-than-minimal risk studies require heightened ethical oversight to ensure participant safety and prevent coercion.
• •National accreditation organizations should require research payment as part of accreditation. Correctional health accrediting agencies, such as the American Correctional Association and the National Commission on Correctional Health Care, should incorporate the review of research policies, including evaluation of policies on payment, into their requirements for accreditation of correctional facilities.
• •Research funders, such as the National Institutes of Health, could require that research studies using their funding must use community-equivalent payment practices for research participants in carceral facilities.
• •IRBs should aim to attain payment parity between research in carceral and community settings.

Importantly, the perspectives of incarcerated individuals must be considered when determining research compensation. Although more research is needed, the limited data available provides important insights. Prior work sought to incorporate perspectives of incarcerated individuals and found most participants indicated an absence of coercive influences in research and felt free to decline to participate (Christopher et al., 2017). Participants identified multiple motivations for research participation, including altruism, trying something new, positive past research experiences, gaining life skills or information, and the desire to break the monotony of incarceration. Additional community-engaged studies are necessary to expand upon how incarcerated people would like to be compensated for research participation.

Remaining questions include whether giving nonmonetary compensation in place of monetary compensation is appropriate, how participants can use the money while incarcerated, timing of payments, and the various impacts these conditions have on the successful implementation of ethical research (e.g., maintaining privacy and confidentiality while obtaining security permission for financial contributions into a commissary account; Berk et al., 2021).

Conclusion

There is a significant need for research involving incarcerated individuals, not only to promote their health and wellness but also to address wider community health disparities. We advocate that research in these settings should not only be permitted but also include fair compensation. Although additional research on this is necessary, we propose that aligning compensation with community standards is a starting place, as it acknowledges the full humanity of incarcerated people and value of their research participation.

Arguably, the most impactful way of addressing these health disparities would be to mitigate the epidemic of mass incarceration. Indeed, the American Public Health Association cites decarceration as an evidence-based practice with the recommendation to “mov[e] toward the abolition of carceral systems and building in their stead just and equitable structures that advance the public’s health” (Conner et al., 2022). Given that this change will not happen rapidly, there remains an immediate need to increase research in carceral settings to reduce health disparities, improve community health, and improve care for the population currently incarcerated (Kinner & Young, 2018).

Efforts must be made at various levels—including local and state facilities, the federal government, and national accreditation agencies—to set compensation standards, evaluate those standards, and, ideally, achieve compensation parity between the community and jails or prisons. More research is needed to understand best research practices in carceral settings and should include the voices of people who are currently and formerly incarcerated.

Authors’ Note

This article represents the views of the authors and not that of the Washington State Department of Corrections.

Authors’ Contributions

K.R. drafted the initial article and led the revision process. M.M. and H.E.J. contributed to the initial concept, writing, and revisions. J.B. supervised the project, including development of the article’s concept, initial drafting, and all revisions.

Author Disclosure Statement

The authors disclosed no conflicts of interest with respect to the research, authorship, or publication of this article.

Funding Information

The authors reported the following sources of funding: M.M., National Institute on Drug Abuse K23DA054003); H.E.J., National Institute of Mental Health (K23MH129420); and J.B., National Institute on Drug Abuse (K23DA055695).