Turning Ideas into Research. Barbara Fawcett

      Three Ethical considerations

      Contemporary expectations include the essential requirement that all research is conducted ethically. The formalization of research ethics can be seen in the growing number of national, institutional and agency-wide research ethics committees that set the parameters and foundations for research ethics approval. This chapter explores understandings of ethics and how these inform the research process. As part of this process, the ways in which certain aspects are prioritized and others rendered less important will be examined. Ethics is clearly more than a risk-management tool, but reductionist practices can serve to devalue outcomes. The process of thinking about a project from an ethical perspective is a requirement, but there may be some disparity about where emphasis is placed and how participants are positioned in this process.

      In this chapter we will look briefly at ethical decision-making based on ethical theories and perspectives and the emergence of codified ethics processes such as professional codes of ethics and research ethics committees. We will then critically examine these in relation to contemporary research approaches of participatory, emancipatory and inclusive perspectives.

      Ethics and research

      In considering ethics and research we must first consider the theoretical, historical and contextual positioning of the ethical bases of decision-making. Ethical discourses underpin the moral basis of decision-making. Put very simply, moral decision-making falls into two broad categories of theories that lie at each end of a continuum. At one end of the continuum are theories that are based on looking at the consequences of the action – decision-making is guided by the idea that an action or decision is ‘good’ because of its effects, for example, the allocation of a limited resource may be based on the idea of the ‘greatest good for the greatest number’. This approach may be used in an emergency situation where resources are scarce, for example it underpins the decision-making in medical triage in disaster and medical emergencies. This of course means that some individuals may not receive treatment or access to the care or service; however, the decision can be justified on the basis of an ethical position about the consequences of the action.

      At the other end of the continuum are ethical theories that are based on the intrinsic nature of the action – it is ‘good because of what it is’. Philosophers arguing this as the basis of decision-making might argue about the sanctity of human life at all costs. The eighteenth-century philosopher, Immanuel Kant, espoused an ethical perspective based on understandings of ‘duty’. This expresses our duty to each other as members of society.

      Ethical philosophers can be located historically and contextually, reflecting the particular era in which their theories were developed. In doing so we understand that emphases and priorities of ethical positioning can be determined by the societal context of the day. For example, John Stuart Mill (1806–73) and Jeremy Bentham (1749–1832) espoused a utilitarian ethical approach, derivative of consequentialism (the greatest good for the greatest number). Utilitarianism privileges the benefits for the entire community over those of the individual. The mid- to late nineteenth century was an era of significant social reform, and this ethical approach to public discourse and provision helped make sense and give meaning to these social developments.

      In contrast, in the postmodern era, feminist approaches, for example Gilligan (1982) and Noddings (1984), suggest that understandings of responsibility rather than duty, and relationships rather than principles, should be emphasized in ethical decision-making (Weber and Pockett, 2011a). These theorists posit that notions of ‘duty’ are in essence patriarchal and oppressive to women in that they place caring roles and relationships in the private rather than the public domain (Gray, 2010).

      Another approach to ethical decision-making is based on the observance of four key principles that are so deeply understood in day-to-day relationships they are often taken for granted. The principles are: respect for autonomy; beneficence (or a duty to pursue the welfare of others); non-malfeasance (doing no harm); and justice (Beauchamp and Childress, 2001). A principles-based approach can be traced back to Hippocrates and the Hippocratic oath and its variations, taken by medical graduates to this day (Glannon, 2002). These four principles can also be identified as foundational elements of the codes of ethics of many other professions, such as social work (Banks, 2001; National Association of Social Workers, 2008; Australian Association of Social Workers, 2010; Weber and Pockett, 2011a).

      The accepted hierarchy of these principles in Western societies places respect for autonomy and individuals’ right to make decisions about their circumstances as carrying primacy over the other three principles of beneficence, non-malfeasance and justice. Although generally considered to be universally accepted, this is a contextual assumption that may be challenged in societies where the order of primacy of these principles may not be the same, reflecting different values and beliefs.

      Hugman (2005) states that as part of everyday life, moral positions are taken and decisions are made by everyone. Much of this is implicit: people may not be required to give a reasoned account of principles when they make a decision about something that might be ‘good’ or ‘bad’, ‘right’ or ‘wrong’. In the practice domain, ethics has underpinned the differentiation of ‘professions’ and professional practice from other occupations. Professions ascribe to codes of ethics that provide guides for professional ethical behaviour. Professional ethics is an extension of the ethics of everyday life but is different in that professionals must be able to analyse the ethical component of a situation logically, thus being explicit. The professional carries responsibility for this task and it cannot be delegated to others (Hugman, 2005).

      Although aspiring to ‘do the right thing’ in all situations, the complexities and dilemmas of practice may result in the practitioner identifying more than one course of action that can be justified. It is in these situations, when limited assistance can be found in codes and guides, that practitioners’ understanding of values and ethics becomes crucial. Ethical knowledge must be interrogated critically, providing a way forward for practice. The ability to reason and articulate an ethical position drawing on ethical knowledge and principles remains one of the hallmarks of the professional.

      This same knowledge is the basis of the ethical stance taken in research ethics. It is only in very recent times, since the Second World War, that research ethics has been based on codified approaches. Research ethics as a specific field of ethics emerged in 1947 with the publication of the Nuremberg Code (US Department of Health and Human Services, 1949). This was in response to the atrocities inflicted on prisoners of war and those in concentration camps in the name of scientific experiments during the war years. Further developments in the decades that followed have resulted in universally accepted codes for ethical research. These codes are continually reviewed and updated to keep pace with scientific and biomedical advances under the auspices of groups such as the World Health Organization and the World Medical Association through the Declaration of Helsinki (World Medical Association, 1964).

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