Research that involves human subjects or participants raises unique and complex ethical, legal, social and political issues. Research ethics is specifically interested in the analysis of ethical issues that are raised when people are involved as participants in research. There are three objectives in research ethics
The five main principles of ethics are usually considered to be:
- Truthfulness and confidentiality.
- Autonomy and informed consent.
Two concepts that you may commonly face in your day-to-day practice are truthfulness and confidentiality. Truthfulness is about telling the truth to someone who has the right to know the truth. For example, if you have been informed about the result of an HIV test taken by someone in your community who then asks to know his/her result, you should tell the person the truth even though this might be very upsetting to that person. The concept of truthfulness urges the professional not to lie.
Autonomy is another ethical principle that you may already be aware of, but not know by that name. The term refers to every individual’s right of self-determination, independence and freedom to make their own choices. In the context of healthcare, the concept of autonomy is most concerned with the ethical obligation of the practitioner to respect their clients’ right to make decisions about their own health. Autonomy must be respected even if you, as the healthcare provider, do not agree with the client’s decision. For example, in Case Study 7.1, Chaltu may feel that Almaz’s parents should know what has happened to their daughter, but you must respect Almaz’s right to maintain confidentiality about her condition.
However, there are conditions in which that personal choice or autonomy may be restricted because of concern for the wellbeing of the community. For instance, if a communicable disease, such as tuberculosis, is diagnosed, clients can be required to take prescribed medication and may have to be isolated to prevent the spread of the infectious agent to others.
Informed consent means that each person who has any sort of procedure done to them in a healthcare context should give their approval for that procedure to be done to them. In order to be fully informed, it is the duty of the healthcare worker to tell the person exactly what the procedure will involve as well as the things that might happen if the procedure is not carried out. In Case Study 7.1 it is clear that Almaz will need further treatment at the health centre and that she will need to give her informed consent for this to take place. There is an ethical obligation on Chaltu, her Health Extension Practitioner, to explain to Almaz what will happen at the health centre, but also the possible consequences if she does not attend.
The term beneficence tells you about ‘doing good’ for your client, for instance by providing immunization.
the concept of nonmaleficence tells you to ‘do no harm’ either intentionally or unintentionally to your clients, for instance, not abandoning a client who is in need of your services.
Justice is a complex ethical principle and it entails fairness, equality and impartiality; in other words, it is the obligation to be fair to all people. Most Health Extension Practitioners will understand about justice without necessarily having come across the word itself. The concept of justice will become clearer if you understand the meaning of two categories of justice: distributive justice and social justice.