subject, project or self? thoughts on ethical dilemmas for social and medical researchers

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Sot. Sci. Merl. Vol. 39, No. 7, pp. 949-954, 1994 Copyright ,C 1994 Elsevier Science Ltd

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SUBJECT, PROJECT OR SELF? THOUGHTS ON ETHICAL DILEMMAS FOR SOCIAL AND MEDICAL RESEARCHERS

JANE A. BATCHELOR’ and CATHERINE M. BRIGGS’

‘School of Social Sciences, University of Bath, Avon BA2 7AY England and *Academic Unit of Psychiatry, United Medical and Dental Schools, Guy’s and St Thomas’, London, England

Abstract--In

950 JANE A. BATCHELOR and CATHERINE M. BRIGGS

of informal carers “Given the subject matter, it is understandable that at times some of the interviews proved quite stressful for both myself and the interviewee. It was not unusual for respondents to cry .” ]41.

The content and process of social research are not discrete elements but are closely interrelated, with each impinging upon the other. The content of an interview, for example, will impact upon the process of that interview and vice versa. The unique features of the process and content of social research set the scene for particular stresses and demands upon those having face-to-face contact with subjects and upon the subjects themselves. Some dilemmas then arise directly as a result of the differing needs, expectations and responsibilities of those involved with the research.

NEEDS, EXPECTATIONS AND RESPONSIBILITlES

What needs or expectations arise as a result of the process and content of social research? Who is responsible for meeting or addressing them? The needs of the subjects or participants, the needs of the researcher and the needs of the project will not necessarily coincide. They may conflict, resulting in the needs of one group or individual (usually the most powerful person/s) being met at the expense of others. It is these conflicting needs which pose researchers with many of the ethical problems they experience in the course of their work.

The responsibilities of the project director or supervisor of the research will be to strike a balance between meeting the demands of sponsors or funders whilst also maintaining their credibility by undertaking sound, well-regarded research. Thus they may experience competing pressures, such as to ensure the work is based on reliable and valid data and that they pay due regard to any ethical issues which arise in the course of the research whilst also meeting require- ments to keep to deadlines and to work within budgets.

The needs of social researchers can be summarised in terms of training, preparation and support for undertaking the work. Initial training in research methods is insufficient unless it addresses the possi- bility of the research impacting on the subjects and the needs subjects may have arising from this. Ethical issues such as when it might be appropriate to breach confidentiality need addressing. They also need to be prepared for the potential emotional impact of the work: this needs to be acknowledged in advance of starting any piece of research. For this to happen it is important that their unique position as the one who has direct interaction with the subjects and who builds a rapport with them, possibly resulting in a conflict of loyalties, is acknowledged. Many of these needs are best met when researchers know they are supported by the project, in the form of their research director or supervisor.

The needs of the subjects will extend beyond being dealt with in a respectful way, mindful of issues of confidentiality and anonymity. The experience of taking part in research may result in issues being aired and topics discussed which reawaken painful memories or bring to the surface unfinished emotional business. The subject may have expectations of the researcher regarding support or advice about these or related issues. Taraborrelli [4] writes “Some of the respondents initially equated sociologist with social worker. This led them to request clarifica- tion of the rules governing welfare benefits ,“, It may be that respondents in social research, in making such requests, are not confusing the roles of those interviewing them so much as simply voicing an expectation raised by virtue of taking part in the research. If a person has shown interest in learning about a respondent’s experiences, and has asked questions which have brought up painful memories perhaps never previously shared, it is surely not surprising if the respondent then looks to this person, regardless of their professional role or title, to provide them with some support, information or advice.

The subject is in many ways the least powerful person in the research process. Most participate in a research project believing that their input will in some way benefit others. This can create considerable pressures to stay in the project even when they experience it as stressful or painful, although they may still find the research interviews of value. Although they have the power to withdraw from the research project they can feel morally bound to continue. For example Thoburn et al. [5] cite an adoptive mother who became a research participant. This adoptive mother concluded:

It was possible our experiences, both good and bad, would possibly benefit other families as they worked towards successful adoptions so we felt morally bound to agree As the research study continued over a long period we became quite used to our lady interviewers and totally at ease with them it was at times a relief to talk to them.

It is clear that there are considerable differences in the needs, expectations, responsibilities and power of the three main ‘actors’ in research; namely the project (in the person of the director, supervisor or assessor), the researcher and the subjects. These differences arise in part from the process and content of much social and medical research which serve to exacerbate the different ‘positions’ of those involved in the research process. These differences have the potential to am- plify the ethical dilemmas faced by researchers, unless they are acknowledged and addressed. If they are on the agenda for discussion before and during the research, then the positions of the three main ‘actors’ in the research triangle (see Fig. I) will be relatively balanced.

The project director or supervisor has the greatest power in terms of overall control of the project. They are also subject to outside pressures and influences, such as those from funders. Any pressures such as to

Ethical dilemmas for social and medical researchers 951

PROJECT

/ \ (director/supervisor)

/ \ RESEARCHER SUBJECTS

Fig. 1. Balanced research triangle.

complete and disseminate the research early will be countered by the level of professional commitment to high research standards. These standards are met in part through sound research design, but the director also needs ongoing feedback about the research process to know the extent to which these standards are being achieved. For example, is the research throwing up ethical problems which were not anticipated at the outset? The person who can best know this is the researcher. Thus open lines of communication between the two are important. Yet the research director may feel ambivalent about issues that might, for example, result in losing some of the research subjects and so extend the timetable of the research. This could result in increased ‘distance’ between the project director and the researcher.

At the same time, the greater the rapport established between the researcher and the subjects in the course of face-to-face interaction, the closer they may become. If this is not shared, for example because the researcher feels unable to raise the issues with the project leader then the researcher’s ‘distance’ from the project (or the project’s ‘distance’ from the researcher) will be even greater. As a result the research triangle will become unbalanced, as shown in Fig. 2.

The researchers may be torn in their loyalties, feeling they carry responsibility for the well-being of the subjects with whom they are in contact by having relatively little power to influence the way in which the research is conducted.

PROJECT

I \ (director/supervisor)

RESEARCHER - SUBJECTS

Fig. 2. Unbalanced research triangle.

DAY TO DAY DILEMMAS FOR SOCIAL AND MEDICAL RESEARCHERS

The failure of the research community to address these issues results in researchers facing dilemmas in their work for which they are generally ill-prepared. In practice these typically hinge around whether in some circumstances confidentiality should be breached, whether intervention into the lives of subjects (by researchers or others) as a result of information gathered in the course of research is sometimes appropriate, and how researchers might deal with pressures to use unethical research pro- cedures in order to meet the needs of the project.

Let us consider four fictitious scenarios which illustrate these dilemmas. The first raises ethical issues over confidentiality. A researcher’s remit is to elicit information from homeless teenagers in emergency hostels, regarding their past lives and present emotional or mental state. The nature of the most recent interview with a 16 year old has been quite traumatic for the researcher. The subject being inter- viewed reveals that he is feeling suicidal and has planned his own demise. The researcher faces some difficult decisions. Does he terminate the interview, breach confidentiality and inform a hostel worker? Does he try to assess the likelihood that this young man will act on his suicide threat? Does he carry on with the interview and ignore it or does he leave the interview maintaining confidentiality and carry the burden of this information with him? Bearing the responsibility of such information alone is a heavy enough burden for anyone to carry, let alone a young graduate with little or no interview experience. The crux of the problem is that he is unprepared for such an occurrence. He feels some responsibility to the young man with whom he has set up a rapport, but he is unsure what position his research supervisor might take regarding issues of breaching confidentiality.

Let us imagine a second scenario. A research project is conducted on a time series basis, looking at the psychological health of members of a profession. The researcher obtains psychometric data that indi- cate a high level of distress among those training for the profession, some bordering on severe de- pression/suicidal state. Is the researcher (knowing the identity of the subjects) expected to ignore these results for fear of biasing the future research, or intervene, perhaps offering outside help? Where do the researcher’s responsibilities lie?

For the third scenario, let us imagine a researcher is given the remit to investigate learning disorders amongst adults and carry out various clinical tests. Whilst trying to assess subjects, it becomes increas- ingly apparent that for some the clinical tests are causing inordinate levels of psychological distress. When the project director learns of this and suggests that subjects should be sedated in order to complete the research, does the researcher allow their own belief that this is unethical to be known and therefore


refuse-possibly putting their job on the line-or do they ignore these feelings and carry out orders?

Finally, consider a less extreme example: a young woman graduate appointed as researcher on a project looking at the psychological adjustment of women to the diagnosis of breast cancer. She feels well-prepared by her undergraduate course on research methods to undertake the psychological tests on her sample. However she is totally unprepared for one aspect of the interviews; many of the subjects seek reassurance from her about their prognosis. She comes to dread each interview, in part because they rearouse her own fears (as a woman) about breast cancer. Her dilemma is whether she might safely discuss her concerns for her subjects and for herself with the research director. Will he think she is losing her objectivity, making her unsuitable to undertake ‘scientific’ work? If such issues have not been put on the agenda through discussion in advance of the interviews, she may well decide talking to him is too risky. She may say nothing, but complete the interviews adopting a cool and distant manner as a means of protecting herself. As a result the subjects may be less forthcoming in the interviews and so less research material is gleaned.

Many of the dilemmas described in the preceding scenarios are inevitable and we suggest, on the basis of our combined research experience, not at all unusual. What is unusual is for social researchers to be adequately trained, supervised and supported in dealing with them. Even the best preparation and support will not render social research free of all ethical dilemmas, but it can go a long way towards reducing them. Many researchers undertake research having been inadequately prepared: as a consequence the dilemmas are exacerbated. Subjects, researchers and projects suffer as a result.

STRIVINGS TOWARDS POSITIVISM

We have referred several times to the dilemmas created for researchers by virtue of some of the unique features of social research arising from the process and the content of such work. However we have not so far focussed on one particular aspect of much social and some medical research; that is, concerns over the extent to which it is perceived by the research community at large as scientific. As a consequence of these concerns there are pressures within the social sciences to strive towards methodo- logical traditions legitimated by positivism [6]. In our experience attempts are sometimes made to achieve this simply through the process of ignoring the existence of any possible effects of (or on) the researcher. By adopting such a strategy, those involved in social research (even those undertaking or di- recting qualitative work) are effectively blocked from being able fully to acknowledge the human interactional aspects of their work. In our experience those researchers undertaking the face-to-face work often recognise the impact of this interactional element.

However they also experience having little or no power to acknowledge it or to seek support, perhaps having internahsed notions that researcherrsubject interaction is ‘unscientific’ and so cannot be acknowledged. Hierarchical power structures within research teams, perhaps compounded by gender issues, may exhibit the creation of a climate conducive to open communication over such research issues.

We suggest that even in the tradition of positivism it is necessary to address the interactional nature of the work. As members of the research community we have a responsibility to address those needs and expectations of interviewees which are raised in the process of being a research subject, although not necessarily to meet them ourselves. We also have a responsibility to meet the needs of the researchers.

What are the implications of these strivings towards positivism? As already discussed, they may account for the manner in which the ethical dilemmas of social researchers are largely ignored by those in their own research community, since to address them means acknowledging the existence of researcher-subject interaction. This is reflected in the inadequate content of much training in social research and the poor level of supervision or support on such issues. Social research courses, which are still relatively thin on the ground, generally cover various aspects of ‘active research’ from documentary analy- sis to questionnaire design. Training on interviewing covers the various techniques (e.g. structured vs non-structured, use of non-directive interview probes or control of the interview). Whilst such training is important it is insufficient if it is not supplemented with consideration of such aspects as how to cope with ethical dilemmas and emotionally charged situ- ations faced by the researcher.

The demands of interviewing are sometimes acknowledged by social researchers, especially in the field of family or marital research. For example Cissna et al. [7] used “an experienced marriage and family counsellor” to conduct the interviews in their study of stepfamilies. The reason they gave for this was that the interviewers, because of the nature of the subject matter (marital and parental relationships), were felt to “require considerable interviewer skill.” Implicit within this statement are two assumptions: that the skill required was beyond that of a social researcher and that such skills would be held by experienced counsellors.

Such examples may be the exception. In our experience many researchers using techniques of qualitative, in-depth or open-ended interviews which are most akin to the work of therapists, and call for many of the same skills, are often untrained and unsuper- vised in their practice. Clark and Haldane [8], com- paring the training of those undertaking marital work to those researching marriage write:

Earlier in this part of the book we devoted considerable space to the question of training for marital work; we were forced to acknowledge that training is poorly developed and

Ethical dilemmas for social and medical researchers 953

fairly difficult to obtain. For social researchers wishing to carry out marriage and family studies the situation is quite different: there is no training whatsoever.

If researchers have had any training, it is unlikely it will cover the ethical dilemmas we have addressed. They may have had some preparation on the possible impact of the research upon their subjects, and the ethical issues relating to informed consent and covert research. Fears for the ‘emotional wellbeing’ of the interviewee are sometimes raised as an ethical dilemma. However the ‘emotional wellbeing’ of the interviewer tends to go unquestioned. Researchers in training are unlikely to have looked at the researcher-subject interaction itself or at the possible psychological or emotional impact of the work upon them, although sensitive material has the potential to impact upon the researcher as well as the researched. Nor are they likely to have been encouraged to examine these issues. In our experience researchers are more likely to be encouraged, implicitly or explic- itly, to deny their existence. Reflecting on the research process does not seem to be given credit as being a legitimate or desirable activity. For the majority of social or medical researchers who receive little formal training in research methods, they must learn ‘on the job’, often to the detriment of themselves and their subjects.

Nor are researchers likely to have been encouraged to acknowledge any responsibility towards the subject beyond informed consent and confidentiality. Again this is presumably a consequence of concerns over maintaining high levels of objectivity by trying to ensure that the researcher is only a researcher, and is not a therapist, counsellor or advisor. However we would argue that striving to maintain a degree of objectivity does not mean that we as social researchers can abandon or ignore responsibility for meeting those needs of subjects (which might be for therapy or counselling) which arise in the course of or as a result of the research interviews.

What are the costs of pursuing ‘scientific research’ by not acknowledging the interactional aspects of such work and the ensuing stresses for researchers? Failure to anticipate, acknowledge and address the impact on the researcher will potentially impair their ability to carry out the work appropriately. It may also impair their ability to pursue important but perhaps (for them) very painful issues, resulting in loss of valuable data. It may lead them to deal with such material in an apparently insensitive manner in an attempt to keep the pain or discomfort at a distance. This may result in an unproductive interview which ends with a distressed participant who is unlikely to be open to approaches by other researchers and a poorly functioning researcher who is unlikely to be able to work to their potential in future research. It also results in low quality data. Only when researchers and those involved in training, employing and supervising them address these issues can the demands of social research successfully be

met and the eventual worth of the data extracted and the value of the research in adding to our body of knowledge be maximised.

We would argue that if in the last of the scenarios the researcher had been adequately prepared and supervised, then it could have been anticipated both that the women with breast cancer might look to her for reassurance and that the researcher might find the interviews stressful. A strategy for dealing with these issues could then have been developed in advance. For example the researcher could provide each subject with written details of appropriate counselling services they might use if the research interview raised issues which they wished to resolve. In this way the researcher would have successfully addressed the dilemma of acknowledging and meeting the needs of the subject which arise or are identified in the process of (or as a result of) the research, whilst not losing, abandoning or compromising the research focus. In addition the researcher’s reaction to the process or content of the interviews would have been legitimated. She might have been provided with someone other than her research supervisor to provide support and consultation on these issues.

Clark and Haldane talk of the paradox that social researchers who value the use of openended interviews “pay so little attention to its consequences, both for the researchers and those who agree to take part in their studies” [8, p. 1391. We would suggest that this paradox comes about partly as a result of researchers not acknowledging the interactional aspects of such work, nor addressing the risks and responsibilities which flow from it, in an attempt to fit with notions of ‘scientific research’. This may also account for models of support and supervision com- monly used in the field of counselling and therapy so rarely being drawn upon for researchers. The low level of dialogue between social researchers and therapists can then be understood as both a consequence of the different positions they hold on these issues and as a contributory factor in maintaining the status quo.

CONCLUSION: POSSIBLE WAYS FORWARD

Whatever their background or training, common to all social and much medical research is the central- ity of the interaction between research and participant. We suggest this interaction has the potential to be one of the strengths of such research. However, we have proposed that there are constant pressures on researchers to deny this very process. A researcher recognising the interactional nature of the research, including its impact upon her or upon the subject, runs the risk of being labelled by others who are in a more powerful position as losing their subjectivity. Thus researchers sensitive to this issue may find themselves as being defined as overinvolved, unable to retain objectivity; if they are women they may be described as being too emotional. In this way ac-


knowledging the existence of the inevitable interactional process is defined as an area of weakness of the researcher. We would argue this is not a weakness of the researcher but a strength in that they have acknowledged and important feature of the research which must be attended to. Ignoring it or blaming the researcher will not make it go away. The weaknesses, if any, rest with research designs which do not prepare researchers for these issues and which do not provide the necessary training, supervision and support throughout the project and in some circumstances beyond. Research design itself is developed within a culture in social and medical research which continues to be heavily influenced by crude notions of scientific positivism which do not allow for any

acknowledgement of the interactional dimension of the work. In this paper we have made the case that the cost of denying this dimension is poorly functioning researchers, subjects who suffer as a result of participating and research which is not of the quality that it might have been.

How might this situation be changed? Researchers themselves have a part to play; they are not powerless in achieving change. Support groups or networks amongst those conducting social or medical research might become more common, providing a ready forum in which to share and address the challenges faced in this work. When taking on research work, especially around topics which will involve gathering sensitive material, researchers might routinely request

a consultant or debriefer. Workshops on the topic at professional or academic conferences could be effec-

tive in raising the issues and so legitamising them as an inevitable part of the process of much research, not as a problem of or in the researcher.

Those training courses for social research could play an important role in putting these issues on the agenda, including preparing researchers for nego-

tiations with their future employers and colleagues, for example to have a consultant or to set up and resource a support group. Funding applications to grant-giving bodies might also regularly include cost- ings for such support. Indeed these bodies and ethical committees vetting research proposals might take a lead by including in their forms questions about the nature of support to be provided for researchers.

However, the most important first step might be a change in attitude of those currently responsible for supervising researchers, to acknowledge the import- ance and value of addressing the issues we have raised. Attitudes may best change when we are confronted by evidence and information that challenges the assumptions upon which our attitudes are based. Hopefully this paper will in itself have prompted some in the research world to think further about these issues, if only because addressing them is likely to lead to better research data.

REFERENCES

I. May W. F. Doing ethics: the bearing of ethical theories on fieldwork. Sot. Probl 27, 358, 1980.

2. Rogers C. K. Counselling And Psychotherapy. Houghton Mifflin. Boston, 1942.

3. Smitrh H. W. Strategies for Social Research: The Meth- odological Imaginafion. Open University/Prentice Hall, London, 1975.

4. Taraborrelli P. Becoming a carer. In Researching Social Life (Edited bv Gilbert N.). a. 179. Sage. London, “l99j. .

, .

5. Thoburn J., Murdoch A. and O’Brien A. Permanence In Child Care, p. 15. Blackwell, Oxford, 1986.

6. Hammersley M. and Atkinson P. Ethnography: Prin- ciples in Practice, p. 3. Tavistock, London, 1983.

7. Cissna K. et al. The dialectic of marital and parental relationships within the stepfamily. Commun. Mono- graphs 57, 44, 1990.

8. Clark D. and Haldane D. Wedlocked?, p. 139. Polity Press, Cambridge, 1990.

subject, project or self? thoughts on ethical dilemmas for social and medical researchers

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