Download Ethical perspectives in sociological research of medical environment

Romanian Journal of Bioethics, Vol.10, No.4, October-December 2012
ETHICAL PERSPECTIVES IN
SOCIOLOGICAL RESEARCH IN THE
MEDICAL ENVIRONMENT AND ON
VULNERABLE PEOPLE1
Cristina Gavriluţă*
Abstract
In the contemporary context of interdisciplinary, sociological research complements and
overturns many aspects of the different areas of social life. The presence of the sociologist in
institutions with certain characteristics (hospital, asylum, police, prisons, healthcare or
rehabilitation centres, etc.) and the study of vulnerable persons(ill persons, orphans, children
with parents in prison, offenders, etc.) bring back in the centre of attention the ethics of the
research. The three levels of research ethics (procedural ethics, professional ethics and ethical
practice) are analyzed in terms of the dilemmas that are generated when they are related to the
practice and epistemic demands of scientific research. The hermeneutic approach and its
analysis we have assumed is based on the experience in two projects involving the development
of sociological research with vulnerable social groups in the medical environment. The
conclusions of this study restate the importance of training professionals and researchers in
ethical human values and also the importance of flexible ethical tools adaptable to the specific
and conditions of the research.
Key words: procedural ethics, professional ethics, practical ethics, epistemology, objectivity,
ethical dilemmas.
1 The text is based on two major studies in which the ethics component was an important chapter:
Transplantation of organs from deceased donors-psycho-ethical perspectives and moral, socio-cultural,
medical, legal influences within the project co-financed by The European Social Fund through the
Operational Programme for Human Resources Development 2007 - 2013, Priority "Education and training in
support of economical growth and development of knowledge society", key Area of Intervention1.5 "doctoral
and post-doctoral research support", Title: "Postdoctoral studies in ethics of health policy", contract number :
POSDRU/89/1.5/S/61879 and Children of Prisoners, Interventions & Mitigations to Strengthen Mental
health, No. 241988, COPING, FP7-HEALTH-2009-single-stage, Collaborative Project(CP) – Small of
medium-scale Focused Research Project (STREP)
*
PhD Lecturer Cristina Gavriluță , Postdoctoral researcher University "Gr.T. Popa", Iași, Romania, University
"Alexandru Ioan Cuza" Iași, Romania E-mail: [email protected]
115
1.
Research Ethics in
context
interdisciplinarity
environment (organization, rules,
norms), the human factor (medical
administrative staff or patients),
contextual factors (crisis situations, the
preoperative or the postoperative stage,
consultations, etc.) In the study entitled
”Introducing a New Paradigm for
Ethical Research in the Social,
Behavioural,
and
Biomedical
Sciences”, the authors emphasize the
importance of the environment in
which the research is carried out. The
medical world is a controlled
environment and here the individual is
often non-autonomous or partially
autonomous, often being accompanied
by an authorized person. In these
circumstances, it is obvious that the
answers of respondents and thus the
direction of the entire study are also
influenced by the characteristics of the
specific
environment.
Mary
Simmerling, Brian Schwegler, Joan E.
Sieber, James Lindgren, the authors of
the study mentioned above show that,
in such situations, we cannot talk about
credibility and authenticity. [3].
The research may also be
influenced by the investigated people.
The patients’ responses may be
modelled and embellished according to
the severity of the disease or the
difficulty of treatment. The same
authors believe that there is a direct
connection between the severity of the
disease, the lack of autonomy and
independence and the quality of
participation in research. On the other
hand, the investigated subject has more
roles in the everyday life (that of
wife/husband, colleague, member in an
association, parent, child, employee,
etc.)
A study which is carried out inside
the hospital only could refer to the time
spent in the hospital and the received
treatment or other interventions. Thus,
the
of
Nowadays the practice of training
and advanced training in the medical
field is accompanied by inter and
multidisciplinary research. Apparently,
the two research approaches are
located at opposite poles. In reality,
actual experience shows that even
under a highly specialized medical
research, there are other realities that
link directly or indirectly to the studied
field which cannot be ignored.
The sociological study of the health
policy, health legislation, research
services, the medical institution
relationships
of
collective
representations of health and medical
institutions and health research
practices are just a few examples in
this respect.
It should be noted that scientific
research and medical practice today are
faced with ethical [1] and epistemic
challenges. More specifically, the
objectives and the level reached by
scientific research come up with a
series of debates on freedom and
freedom of choice, equality, individual
autonomy, etc., which represent the
principles of research ethics.
In this general context the research
is faced with real ethical and
epistemological requirements. On the
one hand, there is the desire for
objectivity and for obtaining valid and
reliable results; on the other hand there
are a number of limitations given by
the
specific
of
the
working
environment and by the ethical
requirements of the research. [2]
As far as the sociological research
is concerned there can be identified a
series of further ethical limitations.
They are generated by: the institutional
116
the issues connected to the other
dimensions of personal history that
could be important indicators in the
research economy are removed from
the equation. Yet, it is known that
many negative attitudes, behaviours,
images and individual representations
are precisely based on individual
stories and personal experiences.
Keeping all the participants at the
same level is practically impossible
and would contradict both the ethical
and the basic principles of the research.
For this reason we believe that the
qualitative research is the most
recommended in the medical area. By
its nature, it manages to better capture
the complexity of studied phenomena
and also to identify any possible
contaminations or fabricated answers.
Every investigated person matters for
such research and placing it in the
same line with borrowed research
designs which are not adapted for each
person, change results in direct
consequence of modifying their
applicability in practice. Researchers
should
adapt
their
qualitative
investigation strategy on individual
cases. That is especially important for
the research which is conducted with
patients or other vulnerable people.
These limitations vary depending on
the nature of research: exploratory
research, in-depth research, micro or
macro research, quantitative or
qualitative research, etc, of assumed
theoretical
perspectives
and
methodological commitments. For
each researcher the aim of the research
is to obtain objective data to better
express the studied reality.
Basically, the sociologist should
harmonize the different types of ethics:
a procedural ethics [4] marked by the
fulfilment of ethical criteria for
obtaining clearances and approvals,
professional ethics [5] related to
performance and compliance with
professional codes ( ESOMAR code of
2010) and a practical type of ethics [4]
which involves the management of
ethical practice that meet the specific
of the research.
The most appropriate example in
this respect is our participation in a
major postdoctoral project at The
University of Medicine and Pharmacy
„Gr. T. Popa” . Our research has
focused on psycho-social health
perspectives and on the legal issues of
organ donation from deceased donors
having the following objectives:
In this research we used, where
appropriate,
qualitative
methods
(questionnaire)
and
qualitative
methods (semi - structured interview,
documentation). Each stage of the
research and its related instruments
(guide questionnaire, interview guide,
and consent forms) has been
accompanied by the opinion of an
ethics
committee.
The
study
accomplished all the criteria which
respect a procedural ethics assumed
from the very beginning.
Starting
from
the
latest
professional
requirements
code
(ESOMAR from 2010); we have
noticed that there are several
methodological
and
epistemic
constraints in the medical research that
generate ethical dilemmas. To these I
would also add a few practical
constraints.
Thus, the sociological research in
the medical environment receives a
complex approach according to the
types of ethics that are being used.
The three types of ethics
(procedural, professional and practical)
[6] are interdependent and only
teaching,
academic
and
even
methodological requirements make us
117
treat them separately. In reality,
procedural ethics cannot ignore the
professional ethics and vice-versa, as
professional ethics cannot ignore the
situational and practical challenges.
We believe that the nature of
assessment tools, the quality of ethical
research in the medical environment
and also that of the researchers are
basic conditions in carrying out the
research. We will further try to identify
the constraints and ethical dilemmas
that could lead determine research
patterns in line with the ethical and
methodological requirements.
Mitigations to Strengthen Mental
Health, Nr. 241988). Hence, the need
to comply with all principles related to
respect of freedom, human dignity and
integrity, freedom of expression and
freedom of choice, the right to be
informed
and
make
informed
decisions, ensuring the confidentiality
and
protection
of
vulnerable
populations. The COPING European
project is an illustrative example in this
respect. In this case, the ethical
protocol and all the related precautions
that have been taken in terms of
methodological
and
practical
investigation
demonstrate
that
investigating vulnerable persons (in
this case, children whose parents or
carers are deprived of liberty) represent
a major chapter of the research. Similar
demands on research projects are
included in Law 206/2004 on good
conduct in research (Art 2, Art 12.)
In the social practice, ensuring the
individual’s rights and freedoms and
advocating for justice social change
represent two major theoretical
perspectives that transcend the ethical
issues raised in the traditional
commissions. The emergence of new
technologies brings along new ethical
implications. Thus, each specific
aspect needs to be visible in the
research [8]. Specifying and managing
the contextual factors and also giving
pertinent reasoning of their utility from
an ethical point of view can result as
important elements in obtaining the
approval of the ethics committee. In
case of the medical research, setting
limits is a necessity [9]. These
limitations that occur beyond the
fulfilment of the ethical exigency bring
forward a series of challenging issues.
What limits can be set when the social
benefits of research outweigh the
potential risks that could expose the
2.
Ethical
dilemmas
and
constraints for sociological research
within the medical field
2.1. The procedural ethics and
their dilemmas
The procedural ethics sum the
procedures for obtaining a notice of
acceptance for the research from an
ethics committee. The following
aspects
will
therefore
receive
consideration: the ethical foundation of
research, solving possible ethical
issues that occur from the nature of the
research and the accuracy of the
specific instruments of information and
consent.
This formula of ethics appears as a
necessity given the fact that, in today's
society, obtaining and handling data
and results can seriously harm the
individual and the society. [7] Thus,
procedural ethics are aimed at limiting
and
controlling
"costs"
of
knowledge. Thus, any research project
must be based on ethical grounds. We
therefore mention here the ethical
obligation to conclude an ethical
protocol for the European research
projects (for example COPING projet
Children of Prisoners, Interventions &
118
informed subjects and those who give
their consent? What could justify such
limits?
A high-risk research could be
avoided in order to protect the image
of the beneficiary of the research from
the loss of public trust. Loss could only
occur at a scientific level.
Although acceptable from the
ethical point of view, such research
may be prohibited. It is difficult to
ascertain whether the negative
consequences of such study with high
risk would be greater than its adduced
knowledge and progress. Weighing
these arguments, attention is directed
against the tendency to emphasize only
the damage,
while it
would
underestimate the knowledge capital
that was lost [10]. Thereby there is the
need for a fair and equitable
assessment. At the same time, the
research of vulnerable people is
consistently refused, can lead to the
undesirable consequence that precisely
those members of society who would
have most to gain from innovative
treatments cannot benefit from it. A
well-known example mentioned by
Brody refers to institutionalized
children with AIDS who could not
benefit from the latest medical
experiments because they were
considered to be too vulnerable [10].
In the case of victims of trauma or
of violence (children with inmate
parents as in case of the COPING
project, victims of abuse, patients in
advanced stages, etc.), the procedural
ethics require additional measures of
protection from the research risks. This
additional protection lies in the very
basic of respecting human rights and in
the ethical principles regarding the
respect for each study participant.
However, treating these people as
victims of negative experiences would
be a mistake. This would show a lack
of respect for people and the study
would upload a lack of professionalism
[11]. Kelly Wester shows that the
responsibility and the ethics of the
research need to take into account
every aspect starting from the survey
respondents and towards the social
impact [12]. This may be reflected on
the methodology used: it is impossible
to follow a series of indicators and
therefore make some correlations
within the the entire batch.
Other issues connected to the
procedural ethics are the voluntary
agreement and the cooperation of the
respondents. The informed consent is
essential for obtaining the ethical
approval: "The informed consent is a
decision to participate in a survey
taken by a competent individual who
has received the necessary information,
understood the information received
and who, after analyzing the
information received, reached to the
decision to participate, without being
subjected to coercion, influence,
induction or intimidation”[13]. In case
of the sociological research, in general,
the informed consent worked and still
works in a verbal form. Somehow, the
verbal consent represents a guarantee
of anonymity for the participant. In
case of the medical research, where the
involvement of the subjects is much
higher, the informed consent is in a
written form. This approach was also
extended to the research of vulnerable
persons
(e.g., when investigating
children with age 7 or over whose
parents were in prison the written
consent was obtained from parents,
guardians or caregivers with the
express agreement of the child) and to
the sociological studies within the
medical environment. The practice is
legally justified by the fact that
119
sociologists
operate
data
and
information that could affect the
investigated subjects while the later
written agreement clearly states the
conditions of cooperation, the eventual
risks and their acceptance through the
signature of both parties. In current
European research projects the
informed consent is often seen as a
contract between the researcher and the
subjects of the research. This practice
prevents abuses, interpretations and
misunderstandings both from the
researcher and the participants to the
research. .
However,
the
practice
of
sociological research shows that, in
these conditions, the response rate
decreases greatly. The reason is as
simple as possible: people refuse to
reveal their identity and to sign the
consent form, showing disbelief and
suspicion.
In the case of quantitative research
where we operate with large samples
there is the risk of not reaching the
minimum number of questionnaires
that will allow the retrieval of results
that can be later extrapolated to a
certain level of the population. This is
also the case in interviews. Within the
European project COPING, after using
a questionnaire for children with a
parent in prison and parents /
caregivers, 45 children and caregivers
who should have participated in a
second stage of the research were
selected by means of a mathematical
model. The result was below the
expectations and received many
rejections. Consequently, the database
was further expanded in order to obtain
the number of interviews necessary for
processing and analysis, additional
costs have occurred and the objective
answers were difficult enough to
obtain.
It
is
the
research
team's
responsibility
to
ensure
that
participants understand the procedures
and particularly the inherent risks of
the study [12]. The mere reading of a
standard form does not a guarantee the
full acknowledgment.
The justified demands of a
procedural type of ethics do not stop us
from expressing doubt about certain
aspects: What is the chance of
obtaining objective and valuable
answers for the research in the case of
the written consent? To what extent
does this affect the validity and the
objectivity of the research?
The formula of the informed
consent enables the participants in the
research to take an informed decision.
Accordingly, the researcher minimizes
the risks of the study.
The
instruments
used
by
researchers to ensure that people
understand the nature of the study and
that they are well-informed can take
the form of: a written document, the
informed consent, which includes the
study procedure, as well as the
possibility for the participants to
withdraw from the study without
penalty [12]. The consent may be a
point of divergence between the ethics
of biomedical sciences research and
the professional ethics in social
sciences. This is the result of the fact
that certain researchers in the social
sciences claim a specificity of their
own field referring not only to the
methodology and but also to the ethics
[14].
On the other hand, the dilemmas of
procedural ethics show the necessity,
beyond a series of formal cautions or
not, to reinforce the responsibility and
the degree of morality the researcher
has to show in such a study. The fact is
emphasized by the authors of the study
120
"Expanding Awareness: Issues in the
Development of Ethics Scale year for
the
Social
Work
Profession"
(Nathanson, Ilene L., Elissa D.
Giffords, and Orly Calderon): The
ethics involves the confrontation of
values. Each activity involved in
carrying out the research should
benefit
from
the
participants’
confidence, this task being the ethical
obligation of those who direct the
study. The limits of this obligation are
delimited according to the professional
responsibilities. Reaching an ethical
decision involves identifying the
values to be applied to the situation
and to act in accordance with these
values [15].
studies by creating some professional
practice and ethics standards)
contains
articles
where
the
commitment to comply with the laws,
or to maintain honesty, professional
responsibility,
transparency,
confidentiality and data protection is
expressed.
The sociologists’ responsibility is
therefore divided between the need to
obtain data and results, as objective as
possible, through theoretical and
methodological construction and also
the
requirements
related
to
administration and enforcement of
ethical research.
Although the professional code of
sociologists does not include items
with express reference to the stages of
a research design, it contains enough
elements that can affect the objectivity
and the ethics of the research. They
become even more important in
sociological research within the
medical arena. The researcher's
responsibility is even greater in this
case and the methodological unit must
be perfectly adapted to the research.
Practically, the researcher must take
into account not only the research topic
(e.g., studying abortion, organ
transplantation, suicidal attempts,
chronically ill behaviour, doctorpatient relationship, etc.) but also other
aspects (the selection of the batch [12],
methods of data collection and
analysis, reliability and fidelity
instruments,
implementation
of
research procedures, the timing and the
context of investigating the possibility
of refusals as well as the emergence of
situations that disrupt the investigation,
etc.). Each of these includes not only
epistemic and methodological demands
but also genuine ethical issues.
Therefore we can talk about an ethical
2.2. The professional ethics of
sociologists and their dilemmas
Sociologists, like all researchers,
are subjected to a number of
requirements arising from the code of
this profession. The professional
ethics, in this case, have two sources:
the first source is scientific and
includes the compliance with all the
rules and the criteria necessary to
design, conduct and conclude a process
while the other source is ethical and
regards the relations between the
researcher, the client, the investigated
population and third parties, as well as
other ethical elements of the research.
The code of sociologists does not
insist on all the details of the research
but on the general principles
underlying the research that respect the
basic ethical principles.
For example, the ESOMAR code (
ESOMAR was founded in 1948 and is
an international organization of over
5.000 members of over 100 countries
that aims at improving the sociological
121
approach to methodology building.
Poorly designed studies can be
regarded as lacking of ethics or
morality, either because of their lack of
validity, reliability and social validity
of the results, or because of the
possible negative impact that the
results might have, or because of the
risk or the potential harm caused to the
participants. That is why we believe
that the design of a study includes
aspects of ethical issues.
The professional ethics also extend
towards the analysis of the results,
their publication and debate. The
researcher is responsible for their
presentation, interpretation and for
drawing out the results of the research
[12].
The professional ethics of the
sociologists are, therefore, not just a
simple formal recipe covering the
researcher
from
ethical
and
deontological point of view. This is a
lesson that accompanies each step of
the approach. The process of making
ethical decisions in the field of the
sociological research is similar to
making decisions in the medical field,
sharing the same basic ethical
principles of beneficence (or nonefficiency), the respect for persons and
justice [12]. However, the dilemmatic
situations where the decision making
process is difficult, are not rare, either.
For example, we recall certain basic
elements of the professional code of
sociologists (ELSOMAR).
The first issue concerns the
compliance with the laws and
regulations in force. However, quite
often there are questions and dilemmas
regarding the likelihood of research as
valid as possible taking into account
the fact that the law may leave room
for interpretation. To these we would
add the specificity of the rules and the
regulations of the institution and of the
investigated environment. [26]. For
example, in the case of the health
facilities, these requirements multiply
in a justified manner because of the
specific environment. This is a good
effect but it limits the possibilities of
investigation, diagnosis and prognosis
which a sociological study could offer.
The ethical behaviour and similar
actions preventing the damage of the
reputation of sociological research is
another current principle in the code
of sociologists. Based on their own
experience,
researchers
question
whether an ethical behaviour always
generates trust. For example, carrying
out research on the relationship
between doctor and patient in a
hospital can generate suspicion and
distrust both from medical personnel
and patients. This happens even though
the research receives the approval from
a commission on ethics and from the
management to perform. That is
somehow understandable provided that
the relation doctor-patient is complex,
involving its contents and secrets.
Therefore, there is a need to
assume an appropriate methodological
construction which does not jeopardize
in any way the objectivity of data. The
sincerity, the honesty, the respect for
the person and his rights, objectivity
and fairness are values that are
subsumed to an ethical behaviour.
However, it is known that many
sociological researches
(Beker,
Howard S. , Geer Blanche, Hughes
Everett şi Stauss Anselm, L., Boys In
White. Student Culture in Medical
Scool, The University of, Chicago
Press, Chicago, 1961; Goffman,
Erving, Asylums Garden City, Double
Day, 1961 ; Griffin John H., Black
Like Me, Penguin Group, New York,
1960; Peneff, Jean, L’hopital en
122
Urgence Métailié, Paris, 1992, etc.) use
as methods (the observation, for
example) which do not require the
previous
information
of
the
investigated subjects, in order not to
change the natural, usual behaviours,
and not to alter the facts. A special
case is that of clandestine observation:
"the undeclared observer does not
negotiate the entry into this
environment, does not address to an
individual or an institution in order to
request
the
authorization
for
observation. He cannot promise
anything and he does not obtain any
warranty. He will work totally
clandestinely. He will neither be able
to take notes during the action, nor to
take additional information from the
participants. "[16] The research
conducted
by
Festiger
(the
investigation
"L’
Echec
d’une
prophetie" which was developed in the
'50s) or (Laud Humphreys, Tearoom
Trade, 1970) are striking examples.
This kind of research carried out in
special environments can even become
hostile, raising serious ethical issues.
The obtained and published results
show that the professional ethics work
even if the ethical conditions for the
research have not been formally met.
"Without
having
made
any
commitment to anyone, the observer is
prevented by a code of implicit
deontology from revealing the identity
of the observed individuals, both in the
final report and in any other form."
[12] There are, thus, structured and
also default formal ethics. The
existence of both emphasises the
importance of sociologists, their
experience and value in a request.
In the sociological research, a
special status is enjoyed by children,
teenagers and vulnerable persons (a
series of patients can be included in
this category). Is the investigation of
these people ethical? If all ethical
requirements are followed with regard
to these people, which is the credibility
of the information provided by them?
How can we better know these social
categories? These questions are
accompanied by others arising from
respecting the principle that involves
the
voluntary
cooperation
of
respondents
and
the
adequate
information to obtain agreement to
participate in the research. In this case,
the signed informed consent does not
contradict the principle of anonymity
on which the entire sociological
approach is based? Under what
circumstances should be obtained the
signature / person’s data and which is
the safety regime of such data? How is
knowledge produced in limit situations
when the acceptance cannot be
obtained?
The
professional
code
of
sociologists gives the answers to these
questions by the fact that researchers
do not have the right to allow that the
personal data they collect within the
research to be used for other purposes..
The researcher’s autonomy is also
limited. He is obliged to provide the
information to competent authorities
when they have a court order. In
Romania, the right to process personal
information requires the approval of
the National Supervisory Authority for
Personal Data Processing based on the
Law no. 667/2001 (the law on personal
data processing).
The same professional code
emphasizes the fact that the rights of
respondents as private individuals must
be respected by the researchers and
will not be harmed or adversely
affected as a direct result of the
interview within a research project.
How can the individual rights be
123
respected in this case when the results
of a research can generate attitudes,
norms and policies that can sometimes
be constraining?
The researcher must ensure that
the
design,
implementation,
dissemination and documentation are
fair, transparent and objective.
Therefore, does the ethical correctness
always meet the fairness, the
objectivity and the ideals of
knowledge? Unfortunately there are
enough examples where the two do not
match. We believe that the sociological
studies, by their nature, do not present
higher ethical risks than the equivalent
in the medical system. We should
make a distinction between medical
research which has a strong
experimental component with a higher
risk in terms of ethics and the
sociological research in the same
environment. The latter, either in a
quantitative or qualitative register, has
a lower risk through the direct and
immediate ethical implications of the
investigation.
The package of professional ethics
also includes the requirement that the
researchers must respect and comply
with the accepted principles of fair
competition along with the data
privacy and protection [8].
The general principles of the
professional ethics as they are designed
outline several directions which are
absolutely necessary to ensure a fair
behaviour from an ethical and
scientific point of view. However, this
tool fails to exhaust the diversity of
issues and challenges that a research
has to face. That becomes more
evident for the research in various
settings (asylum, hospital, prison, etc.).
For this reason, we believe it is
imperative that formal professional
ethics should be accompanied by the
default ethics.
Such principles as autonomy, noninjury, blessing, justice, fairness are
necessary here. [13]
2.3. Practical ethics and the
related dilemmas
Procedural and professional ethics
have their own limitations arising from
their general character and their formal
appearance. The default professional
ethics are closer related to concrete
situations. It is developed and tested in
what we call practical ethics. In 1995
Komesaroff called it. "The micro
ethics are the complex dynamics
between the doctor and the patient in
clinical practice (...). Although the
term micro ethics was criticized for
setting up a false dichotomy between
the abstract level of bioethics and the
specificity of clinical ethics, micro
ethics offered the necessary language
to describe and understand the need for
practical ethics."[6]
We find that this approach has a
broad application throughout the
medical system. For example, the
health policies in Romania and the
concrete situation of the health system
require to be addressed from the
standpoint of practical ethics. Of
course, these go hand in hand with
ethics and political morality. "It is
obvious that a politician or an official
from the ministry does not understand
anything of the medical treatment. Not
to be left out, he acquires some
medical skills, which he simulates
through expert committees or councils
(...)"[17] As a consequence, the
standards, values and ethics of the
health policies can be questioned when
they do not express and serve a
specific social reality. Although the
forms can be perfectly justified from
124
an ethical perspective and not only
(common European values, the right to
health care, accessibility to services,
the right to free choice and equal
opportunities), in fact – a Professor
Vasile Astarastoae shows– we note the
presence of serious inequalities. These
reforms mainly focused on controlling
medical costs as a central element to
improve the quality of care, leading to
persistent chronic under-funding of
public health [18]. We can therefore
speak about the need for practical
ethics in health system policies. The
fact that many legal measures have
been challenged by their consequences
shows that there is perverse effect from
an ethical point of view even in the
case of political and legislative
formulas designed to ensure and
establish ethics and social justice.
Therefore, the problem is not about to
set the valid form, but to align the
content. In fact, it is to avoid a culture
of indifference. [19] The famous topic
of forms without substance evoked by
Titu Maiorescu, remains valid today,
too.
A preliminary research on the
mechanisms,
functioning
and
specificity of institutions may reduce
the perverse effects that can occur in
ethics. Practical situations require
proper micro ethics. This time, what
matters
is
the
sociologist’s
collaboration with the institution and
its makers, obtaining consent to
participation in a research, asking
questions, attitude, time and period in
which the investigation is carried out,
the lengths of the investigation, the
place,
managing
unforeseen
circumstances in such a way as not to
impair the quality of data and no to
cause any ethical harm. The risk is
lower if there are implicit professional
ethics marked by professionalism,
accountability, adaptability, social
intelligence and the ability to work
with people. For this reason, it is
important to shape certain debates both
within each field and at the intersection
between
them,
where
these
requirements are discussed and
formalized as much as possible by
developing codes of conduct, moral
norms, etc. It is extremely important
that these rules appear as a natural
emanation of professional debates. In
the
institutionalization
and
professionalizing of ethics within
different fields the experts in ethics
have an important role [20].
One of the most important risks is
the practice of offering some benefits,
bonuses, awards to the investigated
persons. Although this practice gains
more and more audience, enough
questions about the ethics of this
behaviour and the honesty of the
collected information, still remain
valid. Franklin G. Miller and Alan
Wertheimer show that this is also the
case in medical research. It could
affect the independence of the
participants to some extent and
consequently the participation in the
study would be treated differently.
The practicality of this type of
ethics shows that it can be acquired
and developed only in the specific
context of the field experiment. Yet, it
is still developing on an already
existent background, where the
researcher shares moral values, is in
charge of rules and ethical codes.
***
The ideas presented above show
that ethics is a perfectly legitimate
component, no matter the field of
activity in which the reporting is
conducted. In the absence of ethical
125
guidelines, the current context of
development research, practice and
also the policies in different
professional spheres may harm humans
and society in terms of the
fundamental
values
that
any
independent society assumes.
Current
sociological
studies
demonstrate the usefulness of ethical
guidelines, especially when the
investigations are carried out in special
environments or are focused on
vulnerable persons. At the same time,
practice in this field shows that there
may be tensions between procedural
ethics, professional ethics, practical
ethics
and
the
epistemological
requirements of research. In other
words, an impeccable procedural type
of ethics does not absolutely guarantee
the respect of ethics in practice, the
same as the fully compliance to a
professional code cannot necessarily
produce valuable and valid research.
The suggestion and debate of the
three types of ethics mainly aim at
highlighting a very important resource
concerning the scientific research: the
researcher. Without the researcher,
without their intellectual, moral and
human qualities, the research would
suffer a lot. A minimal ethical [21, 27]
research can also be a sign of solidarity
in diversity.[22] We say this because;
beyond the clichés of certain
professional
codes
or
ethical
procedures (otherwise useful) only a
good researcher can find ethical and
valid solutions to the endless
challenges
of
practice.
But,
unfortunately
“we
notice
that
everything that deals with ethics and
its standards is not taught in school’s
curricula, it is not even included either
in the upper secondary education
curricula or in the university one. In
order
to
balance
professional
consciousness with that of the
community and to include it in the
professional consciousness, each of us
must intercede in their own individual
manner, the knowledge and the study
of ethics and bioethics issues being
inseparable from the modern medical
practice.”[23] In Romania, the
secondary and university education
systems provide few classes/courses,
on Philosophy, Ethics and Deontology,
compared to the important place that
ethics now have in the public agenda
of research. Hence the need arises for
philosophical expertise [24]. Only the
good knowledge of human values and
principles could allow their assumption
further development of genuine
responsible behaviours and attitudes.
Otherwise, the ethics of research may
be exercised at the impersonal and
somehow formal level of procedures
and codes.
On the other hand, the analysis of
the three types of ethics also highlights
the need for completing the procedural
ethics and professional codes with
appropriate simple and effective tools.
In this respect, Florin Chirculescu,
Head of Thoracic Surgery Department
of Bucharest Municipal Hospital
declared in a television interview that,
Romanian
emergency
services
seriously lack certain complete
protocols, therefore adaptable, that
could be followed in critical
moments[25]. In the case of
sociological research in the medical
field, we can notice the need for ethical
protocols for the cooperation with the
healthcare environment where the
forms for obtaining the consent, are
adapted to the sociological research in
this environment and not borrowed
from the medical practice and research.
Ethical dilemmas of concrete
research show that, eventually,
126
knowledge arises from the tension
generated by scientific curiosity, the
desire of moving beyond borders,
fundamental and eternal human rules,
principles and values.
Acknowledgement:
This article was co-financed from the European Social Fund by the Sectoral
Operational Programme Human Resources Development 2007 – 2013, within the
project “Post-doctoral Studies in the Field of Healthcare Ethics’ Policies” implemented
by the University of Medicine and Pharmacy “G.T.Popa” Iaşi, the number of the
identification of the contract is POSDRU/89/1.5/S/61879.
Notes and References:
[1]. Abrudan, Elena, Ethical Expertise and Bioethics in Journal for Study of Religions and
Ideologies, vol. 10, issue 30 Win 2011: 399-402
[2]. Morgan John Henry, Ethical, Naturalism in the Thought of Edward O. Wilson A Critical
Review of his Major Works in Journal for Study of Religions and Ideologies, vol. 9 issue
27, Win 2010: 176
[3]. Simmerling M., Schwegler B., Sieber J.E., Lindgren J, Introducing a New Paradigm for
Ethical Research, Social, Behavioral, and Biomedical Sciences ( Part I), Northwestern
University Law Review 101.2 (2007): 837- 838
[4]. Marilys G., Lynn G., Ethics, Reflexivity and „Ethically Important Moments”, Qualitative
Inquiry vol. 10, no. 2, April 2004: 263-270
[5]. Homan, R., The ethics of social research, Longman, London, 1991
[6]. Măgurianu l.A., Ethical Tensions in Research, in vol. Academia Română – Iaşi Branch,
“Gh. Zane” Institute of Economic and Social Research , The Department of Social and
Human Sciences, Eternal Ideas and Values in Socio-Human Sciences. Studies and
Research. Tome XV, Argonaut Publishing House, Cluj—Napoca, 2010: 316
[7]. Frunza, S. Ethical responsibility and social responsibility of organizations involved in the
public health system. Revista de Cercetare si Interventie Sociala, 2011; 32, 155-171.
[8]. Antle, B. J., Regehr C., Beyond Individual Rights and Freedoms: Metaethics in Social
Work Research, Social Work, 48.1 (2003): 135-144
[9]. Boomgaarden, J., Louhiala P., and Wiesing U., eds. Issues in Medical Research Ethics,
Teaching ethics, New York, Berghahn Books, (2003): 9-10; 95-97
[10]. Brody, Baruch A., The Ethics of Biomedical Research, Oxford University Press, Oxford,
(1997): 128
[11]. Simmerling M., Schwegler B., Sieber J.E., Lindgren J, Introducing a New Paradigm for
Ethical Research, Social, Behavioral, and Biomedical Sciences ( Part I), Northwestern
University Law Review 101.2 (2007): 845
[12]. Kelly L. Wester, Publishing Ethical Research: A Step-by-Step Overview, American
Counseling Association, 2011: 2, 5, 8
[13]. Vasile Astărăstoae, Revista Româna de Bioetica, Vol. 7, Nr. 3, Iulie – Septembrie 2009
[14]. Mark I., Iain Hay, Research Ethics for Social Scientists. Between Ethical Conduct and
Regulatory Compliance, SAGE Publications, London, 2006, SAGE Publications, London,
2006.
[15]. Nathanson, I. L., Giffords E. D., and Orly Calderon, Expanding Awareness: Issues in the
Development of an Ethics Scale for the Social Work Profession, Journal of Social Work
Education, vol. 47, nr.1, 2011
[16]. Peretz, H., Methods in Sociology, Observation, Institutul European Publishing House, Iaşi,
2002:75-76
127
[17]. Astărăstoae V., Revista Româna de Bioetica, Vol. 7, No. 3,July – September 2009
[18]. Borcean G., Medical Ethics versus Political Morality in the 21st Century, in Conexiuni
medicale, June 2009, no. 2 (14), p. 75
[19]. Astărăstoae V., Is an Ethical Analysis Necessary for the Romanian Health System? Revista
Româna de Bioetica, Vol. 8, No. 1, January – March 2010
[20]. Afloroaei S., Religious Experience as an Experience of Human Finitude, Journal for the
Study of Religions and Ideologies, vol. 11, issue 32 (Summer 2012): 156
[21]. Frunză S. Minimal Ethics and the New Configuration of the Public Space, Journal for the
Study of Religions and Ideologies, vol. 11, issue 32 (Summer 2012):3
[22]. Rorty R.. Contingency, irony and solidarity. Cambridge: Cambridge,University Press, 1989
[23]. Curcă C. G., Revista Română de Bioetică, Vol. 8, No. 1, January – March 2010
[24]. Frunză M., Ethical Expertise and Bioethics, Limes Publishing House, Cluj-Napoca, 2010:
24-25
[25]. http://www.ciutacu.ro/articol/poveste-adevarata-despre-viata-si-moarte/
[26]. Grad N. O., Pop I. C., Mironiuc I. A., Stem Cell Therapy and Research, Journal for the
Study of Religions and Ideologies, vol. 11, issue 32 (Summer 2012): 191
[27]. Frunză S. Political Ethics, Journal for the Study of Religions and Ideologies, vol. 11, issue
33 (Winter 2012): 222
128