Global Health Ethics
We'll leave the dry definitions of ethics for the textbooks. Here are some more accessible discussions of ethics specifically for those working in low-resource settings.
1. Watch “First, Do No Harm: A Qualitative Research Documentary”
This documentary flips the common refrain “something is better than nothing” on its head - are we in fact doing some harm? Are there unintended consequences of our work or our mere presence as students or researchers? Through interviews with students and developing country and developed country faculty and officials, the film explores these questions.
2. Take a research ethics course intended for research in low- and middle-income countries.
Many students returning from their first global health research experience find that the pre-departure ethics training they received did not always apply to the types of challenges they faced. Indeed, this entire website is trying to make up for that gap! This version of WHO's internal research ethics training is an outstanding resource that picks up where most university-required ethics trainings leave off.
3. Explore practical frameworks for addressing ethics in global health. Perhaps one of these will click for you.
We find the following way of thinking about ethics, presented by Hunt and Godard specifically for student researchers, very helpful when working in low resources settings. They break down ethics into "procedural" and "practical":
Will the selection and recruitment of participants be fair?
Is there a favorable ratio of risk to potential benefits?
What if research participants don’t understand the idea of “consent”?
Should you change your protocol in the field if it’s not working?
This ethical framework for research in developing countries by E. Emanual and colleagues from the NIH's Clinical Bioethics Department provides a practical set of benchmarks for researchers. They've identified the following principles for global health research, which flesh both procedural and practical ethical issues:
1. Watch “First, Do No Harm: A Qualitative Research Documentary”
This documentary flips the common refrain “something is better than nothing” on its head - are we in fact doing some harm? Are there unintended consequences of our work or our mere presence as students or researchers? Through interviews with students and developing country and developed country faculty and officials, the film explores these questions.
2. Take a research ethics course intended for research in low- and middle-income countries.
Many students returning from their first global health research experience find that the pre-departure ethics training they received did not always apply to the types of challenges they faced. Indeed, this entire website is trying to make up for that gap! This version of WHO's internal research ethics training is an outstanding resource that picks up where most university-required ethics trainings leave off.
3. Explore practical frameworks for addressing ethics in global health. Perhaps one of these will click for you.
- These frameworks provide ways to approach your activities and interactions with communities, research collaborators, patients and study participants. As learners we may not fulfill each of these goals, but we may begin to work toward them.
We find the following way of thinking about ethics, presented by Hunt and Godard specifically for student researchers, very helpful when working in low resources settings. They break down ethics into "procedural" and "practical":
- "Procedural ethics" encompasses the norms, standards and procedures related to the ethical planning and conduct of research along with the responsibilities of the researchers.
Will the selection and recruitment of participants be fair?
Is there a favorable ratio of risk to potential benefits?
- "Ethics in practice" involves the types of ethical issues that arise in the everyday activities of a research project, including the interactions between researchers and participants.
What if research participants don’t understand the idea of “consent”?
Should you change your protocol in the field if it’s not working?
This ethical framework for research in developing countries by E. Emanual and colleagues from the NIH's Clinical Bioethics Department provides a practical set of benchmarks for researchers. They've identified the following principles for global health research, which flesh both procedural and practical ethical issues:
Principle
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Benchmark (for the full list of benchmarks, see Emanual et al)
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Another way to consider the ethics of our actions in global health work is presented by Pinto and Upshur, who emphasize these four principles in their paper "Global Health Ethics for Students":
4. If you can't get enough, there's plenty to read. Here are some more excellent resources to get you started:
- Humility – Recognize your own limitations; seek direction from the host community; subject everyone to the same moral constraints
- Introspection – Examine your motives and consider who will *really* benefit most from your work
- Solidarity – Ensure that your goals/values align with the community; build local capacity and ongoing relationships
- Social Justice – GH should diminish inequities; consider power relations in current healthcare and funding/trade policies (e.g. debt cancellation)
4. If you can't get enough, there's plenty to read. Here are some more excellent resources to get you started:
- An easy-to-read introduction to both research ethics more broadly and the issues that have been the focus of debate in global health research specifically: "Ethics and Human Rights Concerns in Global Health" from Global Health 101 by Professor Richard Skolnik
- Global Justice and Bioethics, 2012, by Joseph Millum & Ezekiel Emanuel [available electronically through the Yale library]
- "Responsibilities in international research: a new look revisited," 2010, by Solomon Benatar and Peter Singer