Ethical issues in qualitative

research

Martin Stevens
14/02/2013
 Research ethics
• Ethics as a subject
• Where are the limits
• What and why research ethics
• Ethical issues in qualitative research
• Role of ethics and other review processes
 Ethics as topic
Ethics can be thought
of as the study of good
conduct and of the
grounds for making
judgements about
what is good conduct
Trusted, 1987; Birch et
al., 2002)
 What status do ethics have?
• Objectively true?
• Relative to culture?
• Purely subjective?
 Origins of ethics
• Outcome of evolution?
– Ethics develops from mutual delousing?
 Philosophical approaches to ethics
• Absolutist (Kant, Rawls)
– Ethical values exist in themselves
– Rules can be derived that apply to all
• Utilitarian (Mills)
– Actions judged on the basis of their
consequences for the general good
– Allows a more relativist stance – what is good varies across cultures
• Virtue ethics (Aristotle)
– Based on the character of the individual
– ‘Ethical behaviour is seen as less of the application of moral principles
and rules, than as the researcher internalising moral values’
• Value-based model (Cronin)
– Ethics part of the relationships with society
– Emphasis on care and responsibility
 Limitations
• Application in the messy world
• Critiques of feminism, multi culturalism –
(Doppelt, 2002)
• Different conceptions of individuals and
society
• Eg Role of self reflexivity and relationship
 Making moral judgements
• Role of emotion, intuition and Reason
• Neurological basis – ‘ventromedial portion of
the frontal lobes’ (Phineas Cage)
• ‘To know, but not to feel’.

Singer, (2005)
 The Trolley Problem
• Flick the switch ?
• Push the man off the bridge?

Singer, (2005)
 Ethical Principles?
• Respect for persons
• Honesty
• Benevolence
• Do no harm
• Justice
• Particular judgement on
the basis of each case
• Experience and social
construction of ethical
choice
 Research ethics - principles
‘Research is essential to the successful
promotion of health and well-being’

‘The dignity, rights, safety and well-being of

participants must be the primary consideration
in any research study’.

Source – Department of Health Research

Governance Framework
 Why research ethics
• Nuremberg code
• Tuskegee Syphillis study
• Milgram conformity study
• Stanford prison experiment
 Ethics and qualitative research
• Ethical considerations are more complex
than quantitative
– More personal methods
– More intrusive – into the everyday world of the
participant
– Greater role for the researcher-participant
relationship (therefore ethical interaction)
• Only ethical research is good research?
 Ethical considerations of
qualitative research
They are empirical and theoretical and permeate the
qualitative research process. The complexities of
researching private lives and placing accounts in the
public arena raise multiple ethical issues for the
researcher that cannot be solved solely by the
application of abtract rules, principles or guidelines.
Rather, there are inherent tensions in qualitative
research that is charactirised by fluidity and inductive
uncertainty and ethical guidelines that are static and
increasingly formalised (Dence et al 2004: 10)

http://www.respectproject.org/ethics/guidelines.php
Ethical decision-making
 The value of ethics codes and
frameworks and guidelines
• Usually combine different ethical reasoning
and approaches
• A pragmatic set of ethical considerations
• A useful overarching guideline
• Help develop consistent practice
• Not a fixed set of rules
• Researchers can depart from – only after
deliberation
 Guidelines
Respect project Social Research Association
• Responsibilities to Society • Obligations to society
• Professional expertise and • Obligations to funders and
standards employers
• Responsibilities to • Obligations to colleagues
participants • Obligations to subjects
• Ethics committees and IRB’
 Responsibilities to society
• The research aims of any study should both benefit society
and minimise social harm.
• Researchers should endeavour to balance professional
integrity with respect for national and international law.
• Researchers should endeavour to ensure that research is
commissioned and conducted with respect for, and awareness
of, gender differences.
• Researchers should endeavour to ensure that research is
commissioned and conducted with respect for all groups in
society, regardless of race, ethnicity, religion and culture.
• Researchers should endeavour to ensure that research is
commissioned and conducted with respect for under-
represented social groups and that attempts are made to
avoid their marginalisation or exclusion.
• Researchers should endeavour to ensure that the concerns of
relevant stakeholders and user groups are addressed.

http://www.respectproject.org/ethics/guidelines.php
Professional expertise and standards
• Researchers should endeavour to ensure that an appropriate
research method is selected on the basis of informed
professional expertise.
• Researchers should endeavour to ensure that the research
team has the necessary professional expertise and support.
• Researchers should endeavour to ensure that the research
process does not involve any unwarranted material gain or loss
for any participants.
• Researchers should endeavour to ensure factual accuracy and
avoid falsification, fabrication, suppression or
misinterpretation of data.
• Researchers should endeavour to reflect on the consequences
of research engagement for all participants, and attempt to
alleviate potential disadvantages to participation for any
individual or category of person.
• Researchers should endeavour to ensure that reporting and
dissemination are carried out in a responsible manner.
http://www.respectproject.org/ethics/guidelines.php
Professional expertise and standards
• Researchers should endeavour to ensure
that methodology and findings are open for
discussion and peer review.
• Researchers should endeavour to ensure
that any debts to previous research as a
source of knowledge, data, concepts and
methodology should be fully acknowledged
in all outputs.
 Responsibilities to participants
• Researchers should endeavour to ensure that
participation in research should be voluntary.
• Researchers should endeavour to ensure that decisions
about participation in research are made from an
informed position.
• Researchers should endeavour to ensure that all data
are treated with appropriate confidentiality and
anonymity.
• Researchers should endeavour to ensure that research
participants are protected from undue intrusion,
distress, indignity, physical discomfort, personal
embarrassment, or psychological or other harm.
 Voluntary participation
• Limitations in statutory research – eg census
• When does encouragement and persuasion
become pressure?
• Role of gatekeepers
• How to manage proxy participants
The ‘Moral magic’ of consent
• Giving consent confers rights on others
• Witholding or withdrawing consent witholds or removes those
rights
• Consent is a state of mind
– Always refers to an object – consenting to x, y, z and ‘intentional state’
(Hurd 1996: 125)
– therefore is changeable
• Consent is not
– ‘negligent ignorance’ likelihood of something happening
– Just fore knowledge of the occurrence of an action
– just desiring an action
• Consent involves a conscious choice to confer the right to do x y
or z.
• Consent requires
– Capacity to withold consent (ie no duress)
– Capacity to understand what is being consented to (MCA)
Hurd, 1996
 More on consent
• People usually consent to a description of the object not the
object itself
• Therefore – an inaccurate description of the object can mean that
there is no consent
• Consent is a choice to act or deliberately not prevent allow or
facilitate the act of another – it is not intending actions of the
other
• Also consent needs to be freely made – no duress and with
capacity -autonomous person
• There is an open question as to how much someone needs to
know about what they are consenting to
• The theory is that in order to consent you need the similar levels
of autonomy as needed to commit the acts to which one
consents

Hurd, 1996
 Confidentiality
• Why maintain confidentiality?
• A standard promise for researchers
• Anonymity / Confidentiality
• Disclosures of harm to others
• Participants who want to be
named
• Presenting findings
 Protect participants from harm
• What constitutes undue
intrusion, distress or
harm
• What causes the harm –
how to address the
reactions of different
participants
• Are harm and intrusion
ever justified?
 Ethical issues in qualitative research
• Research design
• Researcher/Participant relationships
• Interpretation of data
• Predicting the impact of different methods
on particular participants
– Eg potential source of distress
• Balance benefits with potential harm
• Consider legal requirements in terms of
disclosure of harms
Orb et al 2000
 Making decisions in qualitative
research
• Consider how to balance the moral and
ethical codes of different actors
• Balancing conflicting principles/moral
impulses
• Question the primacy of privacy – relate to
different cultures
• How to respond where the moral codes of
the researcher or the sponsoring
organisation are challenged
 Researcher/Participant relationships

• Increased impact on participants

• Importance of power relationships
• Participation of people in natural
environments
• Deception?
 Research practice
• Where the purpose is to understand
differeing perspectives – how does this affect
a duty of confidentiality?
• Huge value of understanding both sides of a
relationship – adds to the strength of the
research
• Raises ethical challenges
 Example – Research Dyads
Researcher interviewed a married couple, Andy and Bella, about their
care relationship (Andy cares for Bella). She met with them both twice,
speaking first to Andy and then to Bella. While speaking to Andy, Bella
“made herself scarce,” and Andy did likewise when it was his wife’s
turn to talk. Andy and Bella were experiencing difficulties in their care
relationship, and it seemed possible that there was violence between
the couple.

During the first interview with Andy, he mentioned one very tense
episode regarding his care for Bella. The event seemed really important
as a transitional moment in their caring exchanges, and when the
researcher met with Bella, she was keen to hear the other side to the
story.

Forbat and Henderson 2003

‘Stuck in the middle’? Ethical
questions from dyad research
• To what extent would it be ethical
to ask her directly about this episode?
• If Bella speaks spontaneously of the event,
what are the ethics of then publishing
accounts from husband and wife alongside
each other?
• What are the ethical protocols for
confidentiality between research
participants?
Forbat and Henderson (2003)
 Ethical challenges from dyad research
• Conflict of interest
– Between researcher and the participants
– Between the participants
• Imbalance
– In relationship between researcher and participants
– In terms of ethical and ideological concerns
• Taking sides
– Explicit strategies re confidentiality and neutrality and
sharing transcripts
• Intrusion
– Affecting the relationships
– Allow for withdrawal, but consider how to explain to other
party
Forbat and Henderson (2003)
 More ethical challenges from dyad
research
• Inclusion
– How to make sure both parties consent and allow
equal opportunity not to take part or to withdraw
• Influence
– How should issues raised by one party be raised in
interviews with the other – if they do not come up
spontaneously?
• Disseminating results
– Double the information – double the chance of
breaking confidentiality
– Partners recognising their own contribution also
recognise their partners – share transcripts?
 Questions to ask in planning
• What prior discussions about confidentiality will
you have with participants?
• How will you maintain confidentiality within the
process of interviewing?
• How will you handle potential difficulties within
the interview, such as questions about the other
participant, or issues of interest raised by the
other participant?
• How will you deal with the transcription and
transcription return process?

Forbat and Henderson (2003)

Examples of dilemmas (discussion)
• Covert Research
• Breaking confidentiality
• Offering incentives
• Distressing topics
 Sources of ethics review
• National Research Ethics Service
(www.nres.nhs.uk)
• Social Care Research Ethics Committee
(www.screc.org.uk)
• University Research Ethics Committees
http://www.arec.org.uk/
• National Offender Management Service
(www.justice.gov.uk/publications/research-
and-analysis/noms)
Principles of Research Ethics Review
• Reciprocity
• Avoidance of
‘double-handling
• Proportionality
• Independence
‘At Last! An ethics committee that will
• Researcher-led listen to reason’

Securing ethics approval: the route map for social care

researchers http://www.screc.org.uk/files/routemap.pdf
 Other approvals needed
• Research Governance Framework - five domains
(http://www.dh.gov.uk/en/Publicationsandstatistics/Publi
cations/PublicationsPolicyAndGuidance/DH_4108962 )
– Ethics;
– Science;
– Information;
– Health, safety and employment;
– Finance and intellectual property.
• Approvals required from local authority Research
Governance for research involving adult social care
• For research involving NHS patients and staff, Research
and Development approval required from each NHS Trust
involved (Research Passports)
 Other issues around approvals
• Mental Capacity Act (2005) – placed legal
duties on researchers
• Academy of Medical Sciences (2011) –
proposals to streamline clinical research
 Resources
• The Respect Project
– www.respectproject.org/ethics
• The Social Research Association
– www.the-sra.org.uk
• KCL Research Ethics
– www.kcl.ac.uk/innovation/research/support/ethics/i
ndex.aspx
• Department of Health Research Governance
Framework
– www.dh.gov.uk