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Sheikh ZA. Dealing with complicity in fieldwork: Reflections on studying genetic research in Pakistan. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44 Suppl 1:41-56. [PMID: 35322443 PMCID: PMC10078743 DOI: 10.1111/1467-9566.13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
Health-related ethnography undertaken in a context marked by social inequalities and colonial legacies requires critical attention to power imbalances in the fieldwork. In this paper, I draw on my own experiences from studying genetic research in Pakistan. As a Danish-born female researcher with roots in Pakistan, I have followed genetic researchers and families dealing with genetic conditions in Pakistan. Through examples I unearth how encounters in the field were shaped by complicities of being in-between the Danish and the Pakistani, of studying and doing international research at the same time, and of my inaction towards suffering families. I base my analysis on the notion that complicity manifests in a generative, and unavoidable, engagement with both complex structures of inequality and interlocutors. We can never fully understand the specificities or consequences of complicity-whether moral or epistemic-when entering, engaging with or representing our fields. However, by staying constructively with the tensions, instead of attempting to move beyond the discomfort that they might create, we can learn how to deal with the consequences and in that, build further the value of ethnographic activity.
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Affiliation(s)
- Zainab Afshan Sheikh
- Centre for Advanced Studies in Biomedical Innovation LawFaculty of LawUniversity of CopenhagenCopenhagenDenmark
- Centre for Medical Science and Technology StudiesSection for Health Services ResearchDepartment of Public HealthUniversity of CopenhagenCopenhagenDenmark
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Cooper J, Harvey D, Gardiner D. Examining consent for interventional research in potential deceased organ donors: a narrative review. Anaesthesia 2020; 75:1229-1235. [PMID: 32329902 DOI: 10.1111/anae.15039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 01/04/2023]
Abstract
In the last decade, research in transplant medicine has focused on developing interventions in the management of the deceased organ donor to improve the quality and quantity of transplantable organs. Despite the promise of interventional donor research, there remain debates about the ethics of this research, specifically regarding gaining research consent. Here, we examine the concerns and ambiguities around consent for interventional donor research, which incorporate questions about who should consent for interventional donor research and what people are being asked to consent for. We highlight the US and UK policy responses to these concerns and argue that, whereas guidance in this area has done much to clarify these ambiguities, there is little consideration of the nature, practicalities and context around consent in this area, particularly regarding organ donors and their families. We review wider studies of consent in critical care research and social science studies of consent in medical research, to gain a broader view of consent in this area as a relational and contextual process. We contend a lack of consideration has been given to: what it might mean to consent to interventional donor research; how families, patients and health professionals might experience providing and seeking this consent; who is best placed to have these discussions; and the socio-institutional contexts affecting these processes. Further, empirical research is required to establish an ethical and sensitive model for consent in interventional donor research, ensuring the principles enshrined in research ethics are met and public trust in organ donation is maintained.
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Affiliation(s)
- J Cooper
- School of Health Sciences, City, University of London, UK
| | - D Harvey
- Department of Intensive Care Medicine, Nottingham University NHS Trust, Nottingham, UK
| | - D Gardiner
- Department of Intensive Care Medicine, Nottingham University NHS Trust, Nottingham, UK
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Cho RY, Weng J, Lynch K, Ng P, Brown C, Hoens AM, Barry K, Brunham LR, Pimstone S. Priorities for Services in Young Patients With Atherosclerotic Cardiovascular Disease and Their Family Members: An Exploratory Mixed-Methods Study. CJC Open 2020; 1:107-114. [PMID: 32159092 PMCID: PMC7063662 DOI: 10.1016/j.cjco.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/12/2019] [Indexed: 11/26/2022] Open
Abstract
Background Optimal design of clinical programs for patients with premature atherosclerotic cardiovascular disease (ASCVD) (men aged ≤ 50 years, women aged ≤ 55 years) requires an understanding of their priorities. We aimed to explore patient and family priorities for services in clinical programs. Methods We co-designed this study with a Patient Partner Committee using a sequential exploratory mixed-methods design. In Phase I, we conducted semistructured interviews with participants from the Study to Avoid Cardiovascular Events in British Columbia (SAVE BC) (n = 15). In Phase II, we designed a questionnaire based on Phase I data and distributed it to all current SAVE BC participants. We collected close-ended responses (n = 116) and stratified data using participant category (index, family member), age, sex, and number of clinic visits. Results We identified 4 major priorities for services in clinical programs: social support (weight: 62.6%), patient education (weight: 83.5%), mental health (weight: 50.7%), and lifestyle changes (85.1%). To address these priorities, participants wanted ASCVD clinical programs to enable recruitment of their family members, establish a comprehensive education component (with research updates in research programs), deliver mental health screening and support after myocardial infarction, and provide longitudinal sessions to support maintenance of lifestyle modifications. These services were identified in Phase I and verified in Phase II. Conclusion We identified 4 priorities for services in clinical programs designed for patients with premature ASCVD and their families. Further research should be done to elucidate their outcomes and most effective methods to provide these services.
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Affiliation(s)
- Raymond Y Cho
- MD Undergraduate Program, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart Lung Innovation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Weng
- MD Undergraduate Program, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart Lung Innovation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelsey Lynch
- Centre for Heart Lung Innovation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Phoebe Ng
- Centre for Heart Lung Innovation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chad Brown
- Centre for Heart Lung Innovation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Barry
- Centre for Heart Lung Innovation Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Liam R Brunham
- Centre for Heart Lung Innovation Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Simon Pimstone
- Centre for Heart Lung Innovation Centre, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Channeling hope: An ethnographic study of how research encounters become meaningful for families suffering from genetic disease in Pakistan. Soc Sci Med 2019; 228:103-110. [PMID: 30904814 PMCID: PMC6481513 DOI: 10.1016/j.socscimed.2019.03.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/24/2022]
Abstract
The Pakistani population has become particularly interesting for international genetic research due to its high rates of consanguinity. Based on 5 months fieldwork in Faisalabad among Pakistani genetic researchers from December 2015–January 2016 and February–April 2017 and interviews with 36 families and 14 researchers, this article focuses on research encounters. It demonstrates how genetic research figures in the lives of families affected by genetic medical conditions in light of their everyday struggles with disease, and considers their perspectives on destiny and hope. Through examining the potentials of the research encounter, we ask how research becomes meaningful in the lives of Pakistani families affected by genetic disease: how these families and individuals enable different modes of sharing tragic stories, contemplating hope and contesting logics of consanguinity. International genetic research depends on human raw material. If we wish to understand the precarious lives this research relies on, then the everyday struggles with disease, and the perspectives of families must be methodologically and theoretically engaged. Ethnographic study of genetic research encounters in Pakistan. Illustrates suffering and hopes of families responding to genetic disease. Discusses researcher-participant interaction in genetic research. Calls for a focus on how research participation becomes meaningful for families.
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