Abstract
BackgroundDespite recent developments aimed at creating international guidelines for ethical global health research, critical disconnections remain between how global health research is conducted in the field and the institutional ethics frameworks intended to guide research practice.DiscussionIn this paper we attempt to map out the ethical tensions likely to arise in global health fieldwork as researchers negotiate the challenges of balancing ethics committees’ rules and bureaucracies with actual fieldwork processes in local contexts. Drawing from our research experiences with an implementation and evaluation project in Jamaica, we argue that ethical research is produced through negotiated spaces and reflexivity practices that are centred on relationships between researchers and study participants and which critically examine issues of positionality and power that emerge at multiple levels. In doing so, we position ethical research practice in global health as a dialectical movement between the spoken and unspoken, or, more generally, between operationalized rules and the embodied relational understanding of persons.SummaryGlobal health research ethics should be premised not upon passive accordance with existing guidelines on ethical conduct, but on tactile modes of knowing that rely upon being engaged with, and responsive to, research participants. Rather than focusing on the operationalization of ethical practice through forms and procedures, it is crucial that researchers recognize that each ethical dilemma encountered during fieldwork is unique and rooted in social contexts, interpersonal relationships, and personal narratives.
Highlights
IntroductionD’souza et al BMC Medical Ethics 2018, 19(Suppl 1): agenda have led to an increase in interdisciplinary and multinational global health projects that involve investigators or trainees from high-income nations participating in studies in Low-and-middle income country (LMIC) [6, 7]
Despite recent developments aimed at creating international guidelines for ethical global health research, critical disconnections remain between how global health research is carried out in the field and the institutional ethics frameworks intended to guide research practice
Our study explored the impact of a 2.5-year multifaceted mental health school-based intervention, called Dream-A-World (DAW), that was aimed at children between 8 and 10 years of age who were deemed by teachers to be at high risk of developing psychological and behavioural problems in the future
Summary
D’souza et al BMC Medical Ethics 2018, 19(Suppl 1): agenda have led to an increase in interdisciplinary and multinational global health projects that involve investigators or trainees from high-income nations participating in studies in LMICs [6, 7] Numerous ethical guidelines, such as the Nuremberg Code [8], the Belmont Report [9], the International Ethical Guidelines for Biomedical Research Involving Human Subjects issued by the Council for International Organizations of Medical Sciences [10], and the Declaration of Helsinki [11], have been developed to guide the regulation of study design, ethical review, and standards of care in international research, and together they form a cornerstone of ethical research practice [12]. Complex and problematic ethical issues continue to emerge from the interplay between global research protocols and the ways in which such research is manifested locally
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