Both academic and clinicians face conflicts of interest in having to decide how to split their time, effort and skill between patients, teaching, research and their own professional development. Where does their duty lie? To patients, colleagues, students, themselves, or their institutions? This section is about exploring some of the ethics considerations that need to be present in the clinical teaching and research contexts.
Exploitation of vulnerable people
The Declaration of Helsinki establishes clear guidelines upon which to base medical research involving human subjects. The main concern when conducting research on people is that the subjects are often vulnerable to exploitation. The following short section highlights some of these points.
Who are “vulnerable” people? Those who are unable to protect their own interests, and include:
- The very young and very old
- Those who are freedom constrained (prisoners, the mentally handicapped, soldiers, students, women)
- Those who are poor / uneducated / illiterate / powerless / homeless / different (culture) / lacking health care
- In other words, the majority of the world’s population
What does exploitation mean in the context of research? A simple explanation would include the following points:
- Taking unfair advantage of power differentials to do what the researcher wants with no consideration of the physical, psychological, economic, social or legal harm that may occur to the participants
- Using participants to achieve research ends (i.e. advancing knowledge) without disclosing risks and benefits to participants (disrespect)
- Undertaking studies in which the benefit is to participants are small and the benefits (possibly financial) to researchers or research sponsors are large (injustice)
- Denying participants post-trial use of therapies identified as beneficial in the trial, in environments where such treatments are not otherwise available (injustice)
- Changing the milieu in which subjects live through changes in their expectations
How can exploitation be avoided? Developing trust between researchers and subjects, which can be done by:
- Respecting the dignity of subjects by creating accountability in research
- Instilling confidence in the research enterprise
- Ensuring fairness and transparency in the research process
- Affirming ones commitment to human protection, with an emphasis on substance as well as procedure)
Give priority to trials that will:
- Develop collaborative partnerships that enhance health care systems and build capacity
- Provide useful medical knowledge for the host country
- Have a balance of benefits and burdens that are fairly distributed over the short and long term
- Ensure that the benefits of research will flow into health care settings
- Ensure existing disparities are not entrenched by deflecting local human and material resources away from healthcare systems in host countries, towards research
Exploitation occurs on a spectrum from mild to severe, is pervasive in research and in daily life, and major efforts are required to reverse this.
Plagiarism is the “…unauthorised use or close imitation of the language and thoughts of another author and the representation of them as one’s own original work”. Within academia, plagiarism by students, professors, or researchers is considered academic dishonesty or academic fraud and offenders are subject to academic censure.
Some individuals caught plagiarising in academic or journalistic contexts claim that they plagiarised unintentionally, by failing to include quotations or give the appropriate citation. For many, ignorance is no excuse for not giving credit to the original author of the content or ideas that are presented as your own. Having said that, there is significant concern that many assumptions are made with respect to students’ level of academic literacy in higher education. Is it fair to expect students to know what it means to use ideas without attribution? Much more needs to be done to ensure that students are supported during their entry into higher education, especially as it relates to their development in academic literacy.
Plagiarism is not the same as copyright infringement. While both terms are often use with reference to the same situation, they are different concepts. Copyright infringement is a violation of the rights of a copyright holder, when content they created – and which is protected by copyright law – is used without the permission of the copyright holder. Plagiarism, on the other hand, relates to the use of ideas without attribution and credit being given to the originator.
The Creative Commons project is a move towards allowing content creators to publish their works under less restrictive copyright licenses. These licenses allow consumers of content varying levels of freedom in how that content may be re-used and under what conditions that may take place.
- South African Medical Research Council (2010). Book 1 – Guidelines on Ethics in Medical Research: General Principles.
- Anderson L, Pickering N (2008): An ethical review of physiotherapy research. New Zealand Journal of Physiotherapy , 36(3): 138-143.
- Benatar, S. (2002). Reflections and recommendations on research ethics in developing countries.