taylor ( 2015 ) questions the utility of a model in addressing an issue for which there is no evidence . while research may be limited in assessing the capacity of disaster victims to consent , and while taylor explains that none of them [ investigators and irb leaders ] suggested that obtaining informed consent was a particular challenge or barrier to the approval or conduct of research , we are not prioritizing the facilitation of study approval . rather , the model offers a participant - centered approach to consent that aims to provide the highest level of protection for disaster victims who are especially vulnerable and at an increased risk of exploitation as research participants . taylor ( 2015 ) discusses evidence from studies suggesting that recollection of traumatic events can produce adverse reactions  likely minor  in research participants . we ask , why not minimize even this risk by providing participants a secondary opportunity to specifically allow or decline their original contributions to be part of a study ? despite the evidence showing that a limited percentage of subjects express negative feelings about completing surveys in the post - disaster setting , there is room for improvement , especially as surveys are only one form of data collection . informed consent signals an ongoing relationship between researchers and participants that is intended to be , and ought to be , renegotiated over time . consent in escrow provides and emphasizes that responsibility and precisely offers the opportunity to fully respect the autonomy of research participants . taylor ( 2015 ) highlights an existing model with the food and drug administration that  require[s ] the investigator to provide research participants that survive the acute event that made them eligible for inclusion in research in absence of informed consent , the option to refuse to continue their participation. we would like to clarify that consent in escrow is different : research participants are empowered to choose whether their contributions are included in a research study after the post - disaster window has closed , rather than committing data collected immediately following a disaster to research , with the option to withdraw at a later timepoint . this is a critical feature of the model and to the participant - centered , opt - in approach offered . however , as with other traditional models , consent in escrow still allows participants to opt out from study continuation even after tier ii consent is obtained . consent in escrow is already attracting attention for applicability beyond the field of disaster research . its relevance extends to new clinical settings such as biobanking that currently uses registries for recontact , but adds to it by requiring secondary contact from the outset . it has also been discussed in the context of on - the - field concussion research during sporting events where data taken during an incident can have profound implications about an athlete 's return to play . finally , this approach may well be an excellent model for research with refugees , whose initial participation in research is particularly sensitive with the major challenges of  obtaining genuinely informed consent [  ] and second , taking fully into account and responding to refugee participants capacities for autonomy. the consent in escrow model also outlines procedures for cases in which the participant is deceased at time of tier ii contact . we are not proposing that consent in escrow is a substitute for all consent procedures post - disaster , nor does the model dictate any particular method for gathering consent . rather , consent in escrow complements existing models and can be adapted and operationalized in many different ways . we welcome opportunities for continued refinement and dialog on different strategies for the informed consent relationship in the multicomplex changing environment of research in the health sciences .
in this paper , we reply to taylor 's ( 2015 ) peer commentary on consent - in - escrow . specifically , we clarify the utility of this novel approach , the way in which it minimizes risks to participants , and how it differs from existing opt - out methods . 
 we further explore its potential use in fields beyond disaster research .