Introduction to Research EthicsIntroduction to Research Ethics

Africa RWG Workshop

21 May 2003

Stella Kirkendale

Wayne Wilson

Four Corners:Four Corners:Values Clarification ExerciseValues Clarification Exercise

What is “Ethics”? What is “Ethics”? What is “Bioethics”?What is “Bioethics”?

• Ethics are ways of understanding and examining the moral life, or right and wrong human conduct.

• Bioethics is a way of understanding and examining the moral aspects of biomedical research and practice.

Fundamental Principles ofFundamental Principles ofHuman Research EthicsHuman Research Ethics

FHI / N. Herndon

• Respect for persons

• Beneficence

• Justice

• Vulnerable people or groups needing special protection. Who might this be?

– …

– …

– …

Respect for PersonsRespect for Persons

• Autonomy, self-determination

Respect for PersonsRespect for Persons (continued)

— those with limited education— the poor— those with out easy access to health services— women— people in prison— sex workers— gay or lesbian people

• Informed consent

• Autonomy, self-determination

• Vulnerable people or groups needing special protection

• Physical, mental and social well-being

• Risks reduced to a minimum

• Protection of the participant is the most important responsibility of the researcher

FHI / N. Herndon

BeneficenceBeneficence

JusticeJustice

• Equal distribution of risk and benefit

• Equitable recruitment of research participants

• Special protection for vulnerable groups

What is “Ethical Obligation”?What is “Ethical Obligation”?

• An ethical obligation is a required action that must be met “all things considered.”

• Obligations may be strong or weak, or vary from one person to another

What is an “Ethical Dilemma”?What is an “Ethical Dilemma”?

• When two or more obligations require mutually exclusive actions

• When some evidence suggests that an act is right but other evidence suggests it is wrong.

How are “Ethical Dilemmas” How are “Ethical Dilemmas” resolved?resolved?

• Consider whether obligations are being violated

• Examine all viewpoints carefully, critically and openly

• Respect legitimate diversity

Two important ideas to know about:• Genuine uncertainty about the

effectiveness of what is being researched (Equipoise)

• Research being confused with care (Therapeutic misconception)

Research Issues Research Issues Important to EthicsImportant to Ethics

Necessary to understand connection of other key issues and ethics:

• Informed consent

• Standards of care

• Partnerships

Issues Important to EthicsIssues Important to Ethics continued

Informed ConsentInformed Consent

ChallengesChallenges– cross-cultural variability in decision-making– understanding and exposure to to the

scientific research model– beliefs about disease causality– language and literacy levels– undue inducement– social harms – gender or HIV status related

Meaningful Informed ConsentMeaningful Informed Consent

Process – pre-enrollment, enrollment and study participation

Community and CAB involvementAdequate time for counselingLexicon of locally used terms Managing rumours – egs blood draws;

“Devil’s money” Diverse range of methods – drama,

quizzes, comics, role-play, focus groups

Standard of CareStandard of Care

Prevailing standards so minimal – upgrading of services essential to conducting research

Goal – implement reasonable overall improvements through progressively “ratcheting- up”

Benefit all research participants; local health care system, community; ongoing and future research – avoid two-tier system

Partnerships in ResearchPartnerships in Research

An important aspect of conducting research is ensuring the research partners have a role in the research process.

Often the discussion comes down to:

Are they ….

Advisors/ Partners/

Consultants Collaborators

Responsible Conduct of ResearchResponsible Conduct of Research

Shared responsibilities in research process

• Well-designed research

• Adequately reviewed

• Ethically conducted

• Properly disseminated

Partnerships for ensuring Partnerships for ensuring research is “ethical” in the HPTNresearch is “ethical” in the HPTN

• Protocol teams

• HPTN Review Committees (including DAIDS as a member)

• Investigators

• Institutional Review Boards/Ethics Committees

• Community Advisory Processes ( for example, CABs)

Three Partners of ResearchThree Partners of Research

Community/CAB

Site Staff EC/IRB

Partner ResponsibilitiesPartner Responsibilities

Community/CAB

Site Staff EC/IRB

Site Staff ResponsibilitiesSite Staff Responsibilities

Protection of human participants

• Scientific correctness

• Appropriate informed consent

• Confidentiality protection

FHI / N. Herndon

Site Staff

Researcher’s ResponsibilitiesResearcher’s Responsibilities (continued)

• Conduct research according to protocol

• Compliance with Ethics Committee requirements— Report adverse experiences, protocol violations, participant complaints

• Post-study— Long-term interests of participants

Researcher’s Human QualitiesResearcher’s Human Qualities

• Integrity

• Respect

• Compassion

• Professionalism

• Courtesy

• SensitivityFHI / R. Kohler

Sponsor’s ResponsibilitiesSponsor’s Responsibilities

• Select qualified researchers

• Ensure appropriate review, approval and supervision by an Ethics Committee

• Provide policies and procedures

• Monitor the research

Sponsor’s Responsibilities in Sponsor’s Responsibilities in International ResearchInternational Research

• Comply with the local ethical, regulatory and legal requirements

• Ensure the local relevance of the research while involving local partners in the development stages

• Promote research integrity

Ethics Committees:Ethics Committees:Research Supervision Research Supervision

• Required by ethical guidelines

• Names of committees vary by location

• Primary purpose is to protect human research participants

EC/IRB

Ethics Committee MembershipEthics Committee Membership

Qualified• Area of expertise aligned with type of research

• Local community representatives

• Clergy or other community leaders

• Former study participants

Diverse• Sex

• Age

• Cultural Background

• Initiate and provide feedback on research specific issues

• Voice concerns from the community and study participants

• Take the initiative to understand research and community issues

CAB Members:CAB Members:Connections to the CommunityConnections to the Community

Community/CAB

Ensuring community input is based mainly on the role community has in the process, particularly the role of the CAB.

Are they advisors or partners?

Advisors/ Partners/

Consultants Collaborators

Community Partnership in ResearchCommunity Partnership in Research

• Potentially, there are many different people and organizations who will be affected by research in the community have an investment in what happens to in their community.

• All these people and organizations are called: Stakeholders

StakeholdersStakeholders

stakeholders who are directly affected and invested in an outcome of the research

(Women in prenatal clinics, actual IV Drug Users)

people or organizations that are interested in the outcomes but are not directly affected by it

(Family members of substance users, NGOS providing services, politicians, religious institutions, government, PSB, the Researchers, etc.)

StakeholdersStakeholders (continued)

Indirect

Direct Two types of stakeholders:

• Inform the research team of local issues and concerns that might affect the research

• Advise research team on the development and implementation of recruitment and retention plans and other study documents

• Review and advise protocol team and site staff on the development of the Informed Consent processes to improve informed decision making.

• Ensuring participants’ rights are considered.

Responsibilities of CAB MembersResponsibilities of CAB Members

Participants’ Rights Participants’ Rights

• Information• Access• Choice• Safety• Privacy• Respect• Referrals / follow-up care

CABs should be involved: CABs should be involved:

At a minimum: At the FRONT END of a study in formulating

research questions and approaching the community

IN THE MIDDLE serving as a check point for how things are going.

At the BACK END in interpreting and applying the findings

Community participation is a component of larger Network ethics agenda

Community partnerships must occur at all levels of the research process

Community processes are key to ethical conduct of research

““Community Participation isCommunity Participation is

Ethics In Action!”Ethics In Action!”