Thinking about ethical considerations
Modern ethical approaches derived from the approach developed for use in the extremely sensitive Nuremberg Trials (1949) as a means of assessing whether experimentation on humans was or had been ethically justified. The Nuremberg Code asserted that participants in such research should give voluntary consent, be free from coercion and be able to withdraw at any time, having first understood through clear information the purpose of the research and the methods that would be used. The development of research ethics resulted in acceptance that anyone conducting research should follow the conventions of participants’ confidentiality, anonymity and the right to withdraw. The Nuremberg Code acted as an important staging post in the development of ethical practices. The medical ethics enshrined in the Hippocratic Oath, believed to have been written in the fifth century bce and which medical practitioners still swear today, can be seen as the first principles of ethical practice in which nonmaleficence, or do no harm, is a starting point for appropriate professional behaviour. Research behaviour, however, had not been considered in this way until Nuremberg. In the field of medicine, various examples highlight the importance of proper ethical screening of research, from the development of the proposal to dissemination and implementation of the findings. For example, the drug thalidomide that, in a period of about four years, was prescribed to pregnant women to help cure morning sickness was later associated and finally correlated with thousands of birth defects worldwide. This case generated recognition that, before being licensed, drugs should be trialled carefully. Another important project that led to explicit principles for research concerning and involving people was the controversial Tuskegee syphilis experiment in the US. In this study, African-American sharecroppers with syphilis were recruited and were tracked for a 40-year period from 1932 to 1972 to follow the natural development of the disease. Well intentioned, this research project aimed to discern whether sufferers were better off without the treatments for syphilis that, at the beginning of the study, were unpleasant, poisonous and dangerous, and brought uncertain benefit. However, penicillin became the standard treatment for syphilis during the course of the study and, despite the possibility of incorporating treatment by penicillin into it, the researchers continued the trial as originally conceived, with the result that many patients died and children were born with congenital syphilis. A leak to the press in 1972 led to the termination of the research. An immediate inquiry was set up and in 1979 the Belmont Report (Harms, 1979) was published. This report explicitly addressed the need for ethical principles in both biomedical and behavioural research, setting these out as three standards:
respect for persons; beneficence, i.e. greatest gain for the research with minimal risks to research subjects; and justice for participants and potential participants in so far as procedures should be thought through, equitable and not exploitative. However, even insider or action research may trigger, sustain or reinforce a regime of oppression, intended or not, real or imagined. The Milgram (1974) ‘obedience to authority’ experiments arising out of Nuremberg show how classic laboratory-type research in the pursuit of knowledge and truth can be intrinsically very unethical, in this case duping naive subjects to apparently inflicting increasing pain on helpless victims; and the Stanford simulated role-play prison experiment in 1971 (where nominated prisoners from a group of volunteers rapidly become real abused victims of nominated warders, also volunteers) was for ethical reasons rapidly abandoned by the morally attuned and disgusted psychologist Philip Zimbardo because of the rapid onset of a regime of brutality. The examples discussed illustrate three philosophical approaches in play when thinking about making moral or ethical decisions: virtue ethics, deontological ethics and consequentialist ethics. A ‘virtue approach’ (Aristotelian in origin) focuses on people’s character rather than on compliance with a set of rules. Deontological ethics are concerned with moral duty, and consequentialist ethics with rational connections between the application of moral principle and the outcome. Specification of ethical practices is in this territory. It is in the absence of natural ‘virtue’ that contemporary moral codes for practice and for research have been developed. Deontic paradigms are identified with formal codified research protocols dictating what a researcher can and cannot do and hence must obey and follow irrespective of situation (e.g. always obeying the confidentiality clause even when it might be simply immoral). In consequentialist paradigms the researcher is concerned about instrumentally achieving pre-determined research outcomes and needs to work out the best course of action to achieve them. It is the goal of contemporary ethical thinking to produce virtuous practice, even though the manifestation of these intentions is deontic and consequentialist. As Webster states, this is ‘a predictive formula which presupposes that cause and effect are eminently controllable’ (2010). So the ‘moral duty’ of research not to privilege the research over the experience of participants becomes the focus of criticism in the Tuskegee experiment; and the consequence of not observing a moral approach is inherent in the thalidomide tragedy. Aristotle distinguishes further between sophia (wisdom) and phronesis. Sophia is the power to think about the way the world is, and has been equated therefore with science, although this may be a contestable distinction, for the science of Aristotle’s time was inductive (Geertz, 2001) and
based almost entirely on the power of the imagination, rather than deductive and using experimentation to test the imagination as today. Phronesis is variously translated as practical wisdom, common sense or prudence; it brings together knowledge with experience, and is concerned with issues of value and power. In this chapter we show that ethical considerations in research may, for the insider researcher, engender tensions with professional practice that must be continually negotiated and re-negotiated, and lived with beyond the life of the study. Insider researchers at doctoral level usually study part-time whilst working full-time in the profession that then becomes the focus of their study. This means that in managing their location as ‘insiders’ they may necessarily change positions, sometimes frequently, along axes with respect to both their research and their professional practice. Action research – a preferred approach for much practitioner research at doctoral level – requires the researcher to negotiate being insider-outsider at the same time, and these researchers adopt a range of complex positions in relation to people connected to their study and move through them in a much more fluid way. We suggest that phronesis most aptly describes this, that in developing an ethical approach to insider research, the researcher needs to engage their own resources of knowledge and experience to help think through the conflicts, tensions and dilemmas that arise. Whilst there are no correct versions of how tensions should be resolved, there are reflexive pointers to thinking about them that can help the researcher determine what to do at the time.