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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]. 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