Why research ethics should add retrospective review

Fostering public health ethics awareness among medical students through interactive web-based values exchange learning: A cross-sectional study

Medical ethics have traditionally encountered resistance in medical education, with doubts regarding their necessity during preclinical years. Concerns include the practical application of theoretical ethics and favoring the learning of ethics through observation and imitation. Furthermore, ethics courses often focus on codes and regulations and neglect the promotion of moral reasoning and decision-making skills. Therefore, enhancing ethical researcher-training modules is essential for advancing instructional methods and promoting a unified and interactive learning atmosphere. A 3-week course was conducted using the values exchange (VX) online platform to assess the effectiveness of the VX system in involving students and its impact on their perceptions of the importance of research ethics. Accordingly, a blended course was provided as an optional course to the students, and a qualitative course evaluation survey was administered at the end of the course. Sixty-one medical students participated in a pilot-blended research ethics program and the majority (93%) reported a positive learning experience. The course was preferred over traditional classroom-based courses by 80% of the respondents, with 77% reporting increased interest and motivation to study Research Ethics. Over half of the students (57%) reported that the course stimulated their thinking and changed their perspectives on handling medical research issues. Some students (20%) reported improvements in their social and information technology skills. The VX platform was able to meet the expectations of both faculty and students, and fulfilled all dimensions of the Health Professions Learning Environment Conceptual Framework. The VX platform provides an interactive and effective simulated learning environment that promotes ethical research aligned with the Health Professions Learning Environment Framework and fosters core competencies, such as ethical reasoning, decision-making, and cultural respect. Medical schools are encouraged to implement VX to enhance the teaching of research ethics.

Enhancing Reciprocity, Equity and Quality of Ethics Review for Multisite Research During Public Health Crises: The Experience of the COVID-19 Clinical Research Coalition Ethics Working Group

In this paper we report findings from a commissioned report to the COVID-19 Clinical Research Coalition on approaches to streamline multinational REC review/approval during public health emergencies. As currently envisioned in the literature, a system of REC mutual recognition is theoretically possible based on shared procedural REC standards, but raises numerous concerns about perceived inequities and mistrust.

Regulating the disenfranchised: Reciprocity & resistance under the Mental Capacity Act

This paper interrogates the legitimacy of formal ethical regulation regarding people with dementia under the Mental Capacity Act, 2005 in England and Wales. Under the Act, research among people diagnosed with dementia must be approved by Health Research Authority committees, irrespective of whether that research engages with health organisations or service users. As examples, I discuss two ethnographic dementia studies that do not engage with healthcare services, but which nonetheless require HRA approval. These instances raise questions regarding legitimacy and reciprocity in the governance of dementia. Through capacity legislation, the state exerts control over people with dementia, automatically delineating them as healthcare subjects because of their diagnoses. This diagnosis functions as a form of administrative medicalisation, rendering dementia a medical entity and those diagnosed with it the property of formal healthcare. However, many people with dementia in England and Wales do not receive related health or care services beyond diagnosis. This institutional imbalance of high governance and low support undermines the contractual citizenship of people with dementia, wherein state-citizen rights and responsibilities should be reciprocal. In response, I consider resistance to this system in ethnographic research. "Resistance" here is not necessarily deliberate, hostile, difficult or perceived, but rather encompasses micropolitical effects that are contrary to power or control, sometimes emerging from systems themselves rather than individual resistive actors. Resistance can be unintentional, through mundane failures to satisfy specific aspects of governance bureaucracies. It can also be deliberate, through refusals to comply with restrictions that seem cumbersome, inapplicable or unethical, potentially raising questions of malpractice and misconduct. I suggest that resistance is made more probable due to the expansion of governance bureaucracies. On the one hand, the potential for both unintentional and intentional transgression increases, while on the other hand, the capacity for those transgressions to be discovered and rectified decreases, because the maintenance of control over such a system requires vast resources. Behind this ethico-bureaucratic tumult, people with dementia themselves are largely invisible. People with dementia often have no interaction with committees that determine their research participation. This further renders ethical governance a particularly disenfranchising facet of the dementia research economy. The state stipulates that people with dementia must be treated differently because of their diagnoses, without consulting those people. In response, resistance to unethical governance could be intuitively deemed ethical per se, but I suggest that such a simplistic binary is somewhat misleading.

Implementation and coordination of an ethics framework in HBM4EU - Experiences and reflections

Human biomonitoring involves the use of human samples and data to investigate exposure to environmental chemicals and their impact on human health. HBM4EU developed a coordinated and harmonized approach involving 29 countries in Europe plus Israel. Addressing ethical issues has been an indispensable prerequisite, from the application phase, grant agreement, project performance to the closing of the project. HBM4EU has established a better understanding of the ethics in such projects and the need for a standardised way of reporting and handling of ethics and data exchange, securing compliance with ethics standards, transparency, transferability and sustainability. The main reflections were: KNOWLEDGE: Ethics awareness, norms and practices are dynamic and increased throughout the project, much learning and experience is achieved by practice and dialogue.

ATTITUDE

Rules and standards were very diversely known and needed to adhere to local practices.

ASSISTANCE

Good results achieved from webinars, training, help desk, and individual consultations.

STANDARDISATION

Was achieved by templates and naming convention across documents.

MANAGEMENT

The establishment of the SharePoint directory with uploading of all requested documents assisted collaboration and exchange. Also, a designated task for ethics within the management/coordination work package and the enthusiasm of the task leader were essential.

COMPLIANCE

Some, but not all partners were very good at complying with deadlines and standards.

TRANSFERABILITY AND SUSTAINABILITY

All documents are archived in the SharePoint directory while a system assuring updating is recommended.

TRANSPARENCY

Assured by public access to annual ethics reports. The ethics reports bridged to the annual work plans (AWPs).

EVALUATION

The Ethics Check by the Commission was successful.

Better Mechanisms Are Needed to Oversee HREC Reviews

Hawe et al. raise concerns about Human Research Ethics Committees (HRECs) taking a risk-averse and litigation-sensitive approach to ethical review of research proposals. HRECs are tasked with reviewing proposals for compliance with the National Statement on Ethical Conduct in Human Research for the purpose of promoting the welfare of participants. While these guidelines intentionally include a significant degree of discretion in HREC decision making, there is also evidence that HRECs sometimes request changes that go beyond the guidance provided by the National Statement. When HRECs request changes outside their remit, inconsistencies between individual HRECs become more common, contributing to delays in ethical review and reducing the quality of HREC decision making. Improvements to the HREC regulatory system are needed to promote transparency and accountability.

Stakeholders' Experiences of Research Integrity Support in Universities: A Qualitative Study in Three European Countries

Fostering research integrity (RI) increasingly focuses on normative guidance and supportive measures within institutions. To be successful, the implementation of support should be informed by stakeholders' experiences of RI support. This study aims to explore experiences of RI support in Dutch, Spanish and Croatian universities. In total, 59 stakeholders (Netherlands n = 25, Spain n = 17, Croatia n = 17) participated in 16 focus groups in three European countries. Global themes on RI support experiences were identified by thematic analysis. Themes identified were: 'RI governance and institutional implementation', 'RI roles and structures', 'RI education and supervision', and 'Infrastructure, technology and tools supporting daily practice'. Experiences of support differed between countries in relation to: the efforts to translate norms into practice; the extent to which RI oversight was a responsibility of RE structures, or separate RI structures; and the availability of support close to research practice, such as training, responsible supervision, and adequate tools and infrastructure. The study reinforces the importance of a whole institutional approach to RI, embedded within local jurisdictions, rules, and practices. A whole institutional approach puts the emphasis of responsibility on institutions rather than individual researchers. When such an approach is lacking, some stakeholders look for intervention by authorities, such as funders, outside of the university.

Public Trust and Trustworthiness in Biobanking: The Need for More Reflexivity

Low levels of public trust in biobanks are perceived to be a deterrent to participation and a threat to their sustainability. Acting in a "trustworthy" manner is seen to be one approach to ensuring public trust in biobanks. Striving to improve public trust in biobanks and prioritizing the need for institutional trustworthiness are both vital endeavors. However, there has been little discussion in the context of biobanking about the meaning of these two concepts, and the relationship between them. In this article, we argue that it is important to examine this, to ensure clarity around their meaning, as well as their relationship with each other as they apply to biobanking. We conclude by making a series of recommendations for biobanks.

Framing ethical issues associated with the UK COVID-19 contact tracing app: exceptionalising and narrowing the public ethics debate

This paper explores ethical debates associated with the UK COVID-19 contact tracing app that occurred in the public news media and broader public policy, and in doing so, takes ethics debate as an object for sociological study. The research question was: how did UK national newspaper news articles and grey literature frame the ethical issues about the app, and how did stakeholders associated with the development and/or governance of the app reflect on this? We examined the predominance of different ethical issues in news articles and grey literature, and triangulated this using stakeholder interview data. Findings illustrate how news articles exceptionalised ethical debate around the app compared to the way they portrayed ethical issues relating to 'manual' contact tracing. They also narrowed the debate around specific privacy concerns. This was reflected in the grey literature, and interviewees perceived this to have emerged from a 'privacy lobby'. We discuss the findings, and argue that this limited public ethics narrative masked broader ethical issues.

The Risk Management Practices of Health Research Ethics Committees May Undermine Citizen Science to Address Basic Human Rights

Lack of supportive workplaces may be depriving babies and mothers of the health advantages of breastfeeding. This citizen science pilot project set out to engage women in photographing and sharing information on the available facilities for breastfeeding and expressing and storing breastmilk in Australian workplaces. While some useful insights were gained, the project failed in the sense that 234 people ‘liked’ the project Facebook page set up to recruit participants, but only nine photographs were submitted. The heaviest loss of participation occurred after the ethics committee requirements were explained, in particular, the requirement for employer consent to take a photograph, or alternatively, for a participant to agree to bear the risk of taking a photo without permission. The ethics committee also made stipulations about the formality of language to be used. Thus, the project’s potential role as an enabler for health action was neutered. We argue that the ethics requirements worked contrary to our purpose and possibly acted to reinforce the powerlessness some women experience at work.

Reporting of Research Ethics in Studies Focusing on Foot Health in Patients with Rheumatoid Arthritis - A Systematic Review

Research ethics is a fundamental part of the entire research. Patients with rheumatoid arthritis are sensitive group of research participants because their long-term health problems cause significant changes in their foot health. In foot health research, data are usually collected through a clinical assessment of the foot or questionnaires. However, there is limited evidence of the reported research ethics of empirical studies on foot health in patients with rheumatoid arthritis. Therefore this review aimed to analyze the reported research ethics of peer-reviewed empirical studies focusing on foot health in patients with rheumatoid arthritis as research participants. This systematic review used the Medline/PubMed, CINAHL, and Embase databases. A total of 1,653 records were identified, and 32 articles were included in the final analysis. Reporting research ethics in studies of patients with rheumatoid arthritis is fragmented, focusing predominantly on ethical approval and informed consent and lacking a broader discussion about research ethics.

Ethical challenges of researching emergent socio-material-technological phenomena: insights from an interdisciplinary mixed-methods project using mobile eye-tracking

Purpose

This paper aims to discuss research ethics in mixed-methods research (MMR) and MMR development with a focus on ethical challenges that stem from working with technical instruments such as mobile eye-trackers.

Design/methodology/approach

The case of an interdisciplinary mixed-methods development study that aimed at researching the impacts of emerging mobile augmented-reality technologies on the perception of public places serves as an example to discuss research-ethical challenges regarding (1) the practical implementation of the study, (2) data processing and management and (3) societal implications of developing instruments to track and understand human practices.

Findings

This study reports challenges and experiences in ethical decision-making in the practical implementation of the study regarding the relationship to research subjects, the use of mobile research instruments in public places and the interdisciplinary cooperation among research team members. Further, this paper expounds on ethical challenges and recommendations in data processing and management and with a view to societal implications of method development and the aspirations of transdisciplinarity. This study concludes that institutionalized ethics need to become more flexible, while applied ethics and reflection must make their entry into university curricula across disciplines.

Originality/value

Complex interdisciplinary mobile and mixed-methods projects that involve sensors and instruments such as mobile eye-trackers are on the rise. However, there is a significant lack of engagement with practical research ethical challenges, practices and requirements in both mixed-methods and method-development literature. By taking a context- and process-oriented perspective focusing on doing ethics, the paper contributes a concrete empirical case to these underdeveloped fields.

Ethics of Pharma Clinical Trials in the Era of Precision Oncology

Pharmaceutical industry clinical trials are ethically problematic: human research subjects are being used as a means to the end of demonstrating statistically significant efficacy of novel anticancer agents to achieve regulatory registration and marketing approval. Randomized controlled trial design is inequitable since control arm patients are denied access to the postulated best treatment. Most pharma studies do not provide clinically meaningful benefit of increased overall survival and enhanced quality of life (QOL) to cohorts and are not reliably generalizable to real-world patients. Precision oncology now enables prospective identification of patients expressing a specific cancer biomarker to determine their particular eligibility for evaluation of efficiency of molecular-targeted treatments. A patient-centered approach, collecting prospective real-world data in large populations, could provide real-world evidence of cost-effective, sustained clinical benefits of survival and QOL, while preserving the ethical beneficent compact between patient and doctor.