Social Sciences, FLAME University, Pune, Maharashtra, India
Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands.
BMJ Glob Health. 2023 Jul;8(7). doi: 10.1136/bmjgh-2022-011415.
In this reflective essay, we seek to engage in a constructive dialogue with scholars across medicine, public health and anthropology on research ethics practices. Drawing on anthropological research and ethical dilemmas that our colleagues and we encountered as medical anthropologists, we reflect on presumed and institutionalised 'best' practices such as mandatory written informed consent, and problematise how they are implemented in interdisciplinary global health research projects. We demonstrate that mandatory, individualised, written, informed consent may be unsuitable in many contexts and also identify reasons why tensions between professionals in interdisciplinary teams may arise when decisions about ethics procedures are taken. We propose alternatives to written informed consent that acknowledge research governance requirements and contextual realities and leave more room for ethnographic approaches. Beyond informed consent, we also explore the situatedness of ethical practices when working in contexts where decision-making around health is clearly a shared concern. We use vignettes based on our own and colleagues' experiences to illustrate our arguments, using the collective 'we' instead of 'I' in our vignettes to protect our research participants, partners and interlocutors. We propose a decolonial, plural and vernacular approach to informed consent specifically, and research ethics more broadly. We contend that ethics procedures and frameworks need to become more agile, decolonial, pluralised and vernacularised to enable achieving congruence between communities' ideas of social justice and institutional ethics. We argue that global health research can benefit from anthropology's engagement with situated ethics and consent that is relational, negotiated and processual; and accountability that is not only bureaucratic but also constructive. In doing so, we hope to broaden ethical praxis so that the best outcomes that are also just, fair and equitable can be achieved for all stakeholders.
在这篇反思性文章中，我们试图与医学、公共卫生和人类学领域的学者进行建设性对话，探讨研究伦理实践。我们借鉴人类学研究以及作为医学人类学家的同事们所遇到的伦理困境，反思了诸如强制性书面知情同意等假定的和制度化的“最佳”实践，并对它们在跨学科全球健康研究项目中的实施方式提出了质疑。我们表明，在许多情况下，强制性的、个体化的、书面的、知情的同意可能并不合适，并且还确定了在涉及跨学科团队专业人员的伦理程序决策时可能出现紧张关系的原因。我们提出了替代书面知情同意的方法，这些方法既承认研究治理要求，又考虑到背景现实，为民族志方法留出了更多空间。除了知情同意，我们还探讨了在健康决策显然是共同关注的背景下进行伦理实践的情境性。我们使用基于我们自己和同事经验的案例来说明我们的观点，在案例中使用集体的“我们”而不是“我”，以保护我们的研究参与者、合作伙伴和对话者。我们特别提出了一种去殖民化、多元化和本土主义的知情同意方法，以及更广泛的研究伦理方法。我们认为，伦理程序和框架需要更加灵活、去殖民化、多元化和本土化，以实现社区对社会正义和机构伦理的观念之间的一致性。我们认为，全球健康研究可以从人类学对情境伦理和同意的参与中受益，这种同意是关系性的、协商性的和过程性的；并且问责制不仅是官僚主义的，而且是建设性的。通过这样做，我们希望扩大伦理实践，以便为所有利益相关者实现公正、公平和平等的最佳结果。
