This is a discussion about the methodological and theoretical challenges in bringing together qualitative empirical social science research methods together with philosophical ethical analysis to investigate ethical issues in global health research - or more generally.
Yes, that is a big question. When do we move from our screens or armchairs, or libraries and when we act how do we account for the change we may bring about?
On the other hand things are changing around us all the time and decision are being made in the field and in ethics committees. Practical ethics.
Where are you based Jo?
I agree with your point about acting. My research is important but sometimes it's not possible to be a researcher alone. I'm also a person too, with moral responsibilities which come out of where I am situated, what I have witnessed and what I am able to do. I don't think it is acceptable to ignore the ethics around us and just carry on with our research. It's a good question, what are the ethics of being a researcher on ethics?
Thinking a bit more about this; several questions come to my mind:
When do we know/understand sufficiently?
When have we written, published and discussed enough? When is it time to act?
Should/can those applying an empirical approach be involved in bringing about change?
Can one use 'action research' methods in empirical ethics?
I have really enjoyed reading these discussions. I think some of the points raised about studying 'ethics' and acting on 'findings' come back to our positioning in the 'field'.
It also depends very much on how much we understood about the challenges from the outset of our study. Now that I am more aware-have seen- of some of the difficult issues that come up when a trial is conducted within a general paediatric ward in a district hospital in a resource limited setting-I no longer would just be happy to sit and watch the dynamics unfold-. They need to be discussed openly both in the location and in wider forums.
In case anyone is interested, I have just been reading a paper by Erica Haimes and Robin Williams called 'Sociology, ethics and the priority of the particular: learning from a case study of genetic deliberations'. The paper was published in 2007 in the British Journal of Sociology but I've never seen it before. It is interesting. It's written jointly by a sociologist (Haimes) and a philosopher (Williams) and using recruitment to a genetic database in the Uk as a model, explores the difficulties of developing a coherent theoretical apporach and research method which brings together both social science and ethics. The paper is interesting because the approach they decide upon in the end is one based on an Aristotelian concept of 'practical wisdom' built around the idea of 'empirically and normatively informed conversations' as a methodological orientation. I'm not sure it provides an approach that everyone will be happy with but it's worth a look in anycase.
The debate and deliberation over 'in situ' practices (irrespective of their geographic location) is essential to bring about change--as Mikey writes . Uncritical acceptance of certain local practices may actually foster 'disrespect' -empirical Bioethics needs to do more.Drawing on the work of Callahan (2000):' Bioethics does not well serve society simply by promoting a respect for other cultures. That's nice, but not enough. It better promotes the society by helping to develop the criteria and standards for knowing which practices and values should be accepted and affirmed, which simply tolerated, and which rejected. That will not be easy, and will sometimes be thankless. But if bioethics is to be of any value at all, that value will come from its effort to help devise responsible ways of making justifiable moral judgments. All cultures deserve our presumptive respect, but none can claim a moral exemption from scrutiny and evaluation'. As well as Kleinman (1999):' were ethnographers better prepared in ethical reasoning they would be in a nearly ideal situation to project local moral issues and actions into global ethical deliberations and vice versa'.
Kleinman, A. (1999). 'Moral experience and ethical reflection: can ethnographery reconcile them? Aquandary for the "New Bioethics".Daedalus Vol. 128.pp67-97.
Callahan, D. (2000). 'Universalism and Particularism: Fighting to a Draw.' Hastings Center Report 30: 37-44.
i ahve read this and after working in and also after conducting feildwork in a developing country--the issues raised in Emerson et al (2009) are very pertinent vis a vis gender inequality --in most though not all cases(as i am sure it may be in the developed countries).If (and i am sure for most it is) respect for persons is an overarching'aim'then to see disrespect(in any form) towards a person is unethical.However respect also demands that where the person herself wants to 'rely'on family or 'others' then that should be respected too---so there are many facets to this quandary. Another important issue here is whether the reseraher is also from the same community or not.This too has a bearing on the practice.
I have to admit that I haven't read this commentary, but I think this is a really important issue. However, for me, it's an issue that transcends bioethics in resource-poor countries to apply to all contexts in which empirical work seeks to shed light on practical ethical dilemmas.
As I see it, this is an issue that can be traced back to some more foundational questions concerning the nature of empirical ethics: What do we want from empirical ethics research? How are we seeking to intergrate empirical and ethical understanding? How can we elucidate methods that can help us to ensure that the potential of empirical ethics research is realised?
For me, any defensible account of empirical ethics research is one that aims to draw conclusions about normative ethical questions that are of dierct relevance to practice. On such an account, empirical ethicists need to take very seriously the impact that their work will have - and, I believe, ought to have - on shaping the world, both in general and specific to the context in which the research is undertaken.
The methodologies that I think we need to develop for tailoring normative analysis to practical contexts through the empirical research process are exactly those that actively seek to do more than simply produce a detached, objective, and generalisable understanding of an issue. They are about researcher-practitioner partnerships in which reasoning, challenge, debate, deliberation, and change can be facilited and fostered in situ.
If such approaches are to be defensible, they must lead to demonstrable benefit: convincing practical claims that resonate with those closest to the problem, who come to identify, understand and resolve their difficulties and issues through the empirical ethics research process.
Hopefully this will be an enlightening and positively transformative experience, as the instigator of ethically wrong practice recognises the shortfall of her views or actions.
But it might also be disruptive, unsettling, and potentially harmful to both partners in this process as they become cognisant of their beleiefs about, or role or in perpetuating inequality, harm, non-consensual research, exploitation etc.
This for me, is a significant challenge for empirical ethics research, and for the public identity of practical ethicists more generally. It does not, however, seem to be a challenge unique to those working in resource-poor contexts.
Empirical ethics when working with people in resource-poor settings
Quite a lot of the literature on 'empirical ethics' is written by people with limited experience of working in resource-poor countries. I know of only one paper (Emerson et al 2009) - a commentary to a paper on empirical ethics published in AJOB - that deals more specifically with research in resource-poor countries. In this (very short) commentary,the authors argue that when doing empirical ethics in developing countries, researchers have an obligation not only to investigate, but also to address and change unethical practices. The example is gender inequality. When researchers experience gender inequality in an empirical ethics study, they should use their position to address this. I am not sure, however, whether that is desirable/possible/ethically right. I'd love to hear your views on
- whether empirical ethics research in resource-poor countries is different from such research in wealthier countries with higher average levels of education; and
- whether researchers have a moral obligation to actively seek to address or change situations that they perceive to be unethical.
Would love to hear your feedback!
Emerson, C. I., R. Upshur, et al. (2009). "Empirical Bioethics Research in the Developing World: When the 'Is' is Close to an 'Ought'." American Journal of Bioethics 9(6): 101-103.